Provider First Line Business Practice Location Address:
8001 LAUREL CANYON BLVD
Provider Second Line Business Practice Location Address:
STE 207
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91605-1464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-771-9331
Provider Business Practice Location Address Fax Number:
818-771-9970
Provider Enumeration Date:
08/22/2014