Provider First Line Business Practice Location Address:
13143 BASSETT ST
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:
91605-4726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-901-4830
Provider Business Practice Location Address Fax Number:
818-785-3446
Provider Enumeration Date:
03/07/2007