Provider First Line Business Practice Location Address:
13000 HART ST
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:
91605-4801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-255-5200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2026