Provider First Line Business Practice Location Address:
12547 SHERMAN WAY STE I
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91605-7101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-255-0888
Provider Business Practice Location Address Fax Number:
818-255-0882
Provider Enumeration Date:
07/13/2005