Provider First Line Business Practice Location Address:
5032 LANKERSHIM BLVD
Provider Second Line Business Practice Location Address:
STE 5
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91601-4245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-291-3554
Provider Business Practice Location Address Fax Number:
818-483-2382
Provider Enumeration Date:
11/26/2014