Provider First Line Business Practice Location Address:
5032 LANKERSHIM BLVD STE 1
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:
91601-4245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-646-7677
Provider Business Practice Location Address Fax Number:
818-960-0207
Provider Enumeration Date:
11/27/2015