Provider First Line Business Practice Location Address:
12509 OXNARD ST
Provider Second Line Business Practice Location Address:
213
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:
818-980-2169
Provider Business Practice Location Address Fax Number:
818-980-2171
Provider Enumeration Date:
06/08/2006