Provider First Line Business Practice Location Address:
5300 LANKERSHIM BLVD STE 105
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:
91601-3163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-505-0106
Provider Business Practice Location Address Fax Number:
818-505-1063
Provider Enumeration Date:
02/04/2011