Provider First Line Business Practice Location Address:
5200 LANKERSHIM BLVD. STE. 170
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:
90161-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-980-3200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/27/2009