Provider First Line Business Practice Location Address:
6829 LANKERSHIM BLVD.
Provider Second Line Business Practice Location Address:
#12
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:
818-485-2353
Provider Business Practice Location Address Fax Number:
818-937-0909
Provider Enumeration Date:
03/05/2015