Provider First Line Business Practice Location Address:
2001 SOUTH BARRINGTON AV
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-387-0198
Provider Business Practice Location Address Fax Number:
310-472-5989
Provider Enumeration Date:
05/15/2007