Provider First Line Business Practice Location Address:
6455 AND 6457 BAKMAN AVENUE
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:
91606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-572-6438
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2023