Provider First Line Business Practice Location Address:
6631 LAUREL CANYON BLVD
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91606-1546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-765-6671
Provider Business Practice Location Address Fax Number:
818-765-4340
Provider Enumeration Date:
03/26/2007