Provider First Line Business Practice Location Address:
6180 LAUREL CANYON BLVD
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91606-3231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-760-7847
Provider Business Practice Location Address Fax Number:
818-762-1736
Provider Enumeration Date:
03/07/2007