Provider First Line Business Practice Location Address:
4605 LANKERSHIM BLVD STE 617
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:
91602-1856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-824-3499
Provider Business Practice Location Address Fax Number:
818-301-1996
Provider Enumeration Date:
02/01/2022