Provider First Line Business Practice Location Address:
7821 FARMDALE AVE.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-262-1786
Provider Business Practice Location Address Fax Number:
323-262-2659
Provider Enumeration Date:
03/29/2007