Provider First Line Business Practice Location Address:
6829 LANKERSHIM BLVD UNIT 206
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:
91605-6109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-649-3194
Provider Business Practice Location Address Fax Number:
818-649-3258
Provider Enumeration Date:
07/01/2021