Provider First Line Business Practice Location Address:
4821 LANKERSHIM BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91601-4538
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:
818-766-9755
Provider Enumeration Date:
05/04/2007