Provider First Line Business Practice Location Address:
8025 WEBB AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91605-1505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-767-4215
Provider Business Practice Location Address Fax Number:
818-767-4483
Provider Enumeration Date:
12/06/2006