Provider First Line Business Practice Location Address:
3200 MOTOR AVENUE
Provider Second Line Business Practice Location Address:
VISTA DEL MAR CHILD AND FAMILY SERVICES
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-836-1223
Provider Business Practice Location Address Fax Number:
310-838-2791
Provider Enumeration Date:
03/15/2007