Provider First Line Business Practice Location Address:
627 N LARCHMONT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90004-1307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-387-7965
Provider Business Practice Location Address Fax Number:
213-632-3192
Provider Enumeration Date:
10/26/2006