Provider First Line Business Practice Location Address:
12650 SHERMAN WAY
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91605-5232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-764-5775
Provider Business Practice Location Address Fax Number:
818-764-6273
Provider Enumeration Date:
12/21/2006