Provider First Line Business Practice Location Address:
5953 LAUREL CANYON BLVD STE A
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:
91607-5224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-235-5688
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2011