Provider First Line Business Practice Location Address:
8217 LANKERSHIM BLVD
Provider Second Line Business Practice Location Address:
5
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91605-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-768-7717
Provider Business Practice Location Address Fax Number:
818-768-7718
Provider Enumeration Date:
02/25/2007