Provider First Line Business Practice Location Address:
11516 OXNARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91606-4810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-769-9551
Provider Business Practice Location Address Fax Number:
818-769-2131
Provider Enumeration Date:
12/04/2006