Provider First Line Business Practice Location Address:
14215 1/2 MOORPARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91423-2730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-858-5641
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2025