Provider First Line Business Practice Location Address:
8250 LANKERSHIM BLVD SPC 15
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:
91605-0003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-213-6296
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2025