Provider First Line Business Practice Location Address:
501 S BUENA VISTA ST
Provider Second Line Business Practice Location Address:
NEUROSCIENCE INSTITUTE, FIRST FLOOR
Provider Business Practice Location Address City Name:
BURBANK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91505-4809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-847-3271
Provider Business Practice Location Address Fax Number:
818-847-4842
Provider Enumeration Date:
04/23/2007