Provider First Line Business Practice Location Address:
5907 LANKERSHIM BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91601-1006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-980-3073
Provider Business Practice Location Address Fax Number:
877-340-3470
Provider Enumeration Date:
07/21/2005