Provider First Line Business Practice Location Address:
4914 LANKERSHIM BLVD STE 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91601-5376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-508-2926
Provider Business Practice Location Address Fax Number:
209-508-2929
Provider Enumeration Date:
10/11/2024