Provider First Line Business Practice Location Address:
8216 LANKERSHIM BLVD STE 16
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:
91605-1699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
747-236-5550
Provider Business Practice Location Address Fax Number:
747-236-5005
Provider Enumeration Date:
08/27/2026