Provider First Line Business Practice Location Address:
6342 LAUREL CANYON BLVD
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:
91606-3213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-337-5574
Provider Business Practice Location Address Fax Number:
818-337-5569
Provider Enumeration Date:
05/29/2025