Provider First Line Business Practice Location Address:
3424 LONGRIDGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91423-4914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-783-8342
Provider Business Practice Location Address Fax Number:
818-386-1210
Provider Enumeration Date:
07/03/2007