Provider First Line Business Practice Location Address:
5969 LANKERSHIM BLVD
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:
91601-1006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-761-4235
Provider Business Practice Location Address Fax Number:
818-761-4871
Provider Enumeration Date:
05/11/2017