Provider First Line Business Practice Location Address:
3800 BARHAM BLVD STE 322
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:
90068-1095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-265-7179
Provider Business Practice Location Address Fax Number:
213-265-7581
Provider Enumeration Date:
04/18/2014