Provider First Line Business Practice Location Address:
12509 OXNARD ST
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91606-4467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-308-6255
Provider Business Practice Location Address Fax Number:
818-358-2069
Provider Enumeration Date:
10/07/2013