Provider First Line Business Practice Location Address:
5200 LANKERSHIM BLVD STE 170
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:
91601-3184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-216-5473
Provider Business Practice Location Address Fax Number:
213-216-5473
Provider Enumeration Date:
06/17/2008