Provider First Line Business Practice Location Address:
8237 LANKERSHIM BLVD STE C
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:
91605-0983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-659-9958
Provider Business Practice Location Address Fax Number:
818-659-9723
Provider Enumeration Date:
05/14/2021