Provider First Line Business Practice Location Address:
2116 W BEVERLY 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:
90057-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-483-8754
Provider Business Practice Location Address Fax Number:
213-483-8755
Provider Enumeration Date:
10/31/2006