Provider First Line Business Practice Location Address:
8239 LANKERSHIM BLVD STE D
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:
91605-1659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-768-0695
Provider Business Practice Location Address Fax Number:
818-768-1576
Provider Enumeration Date:
02/06/2007