Provider First Line Business Practice Location Address:
5953 LAUREL CANYON BLVD
Provider Second Line Business Practice Location Address:
STE #B
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-508-7200
Provider Business Practice Location Address Fax Number:
818-754-0400
Provider Enumeration Date:
09/13/2006