Provider First Line Business Practice Location Address:
8001 LAUREL CANYON BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
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:
818-767-5782
Provider Business Practice Location Address Fax Number:
818-504-1959
Provider Enumeration Date:
04/29/2008