Provider First Line Business Practice Location Address:
1400 S HAYWORTH AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90035-4813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-729-9588
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2008