Provider First Line Business Practice Location Address:
5200 LANKERSHIM BLVD
Provider Second Line Business Practice Location Address:
SUITE 170
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91601-3155
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:
818-980-3203
Provider Enumeration Date:
09/03/2010