Provider First Line Business Practice Location Address:
6147 CARPENTER AVE
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:
91606-4701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-209-3352
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2026