Provider First Line Business Practice Location Address:
4821 LANKERSHIM BLVD STE B
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:
91601-4572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-508-7300
Provider Business Practice Location Address Fax Number:
818-301-2566
Provider Enumeration Date:
08/03/2021