Provider First Line Business Practice Location Address:
4418 VINELAND AVE
Provider Second Line Business Practice Location Address:
SUITE 218
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91602-3457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-275-2243
Provider Business Practice Location Address Fax Number:
818-980-3221
Provider Enumeration Date:
07/18/2013