Provider First Line Business Practice Location Address:
5352 LAUREL CANYON BLVD STE 110
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:
91607-4921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-206-2655
Provider Business Practice Location Address Fax Number:
818-357-5541
Provider Enumeration Date:
07/03/2006