Provider First Line Business Practice Location Address:
1130 NORTH LA BREA AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90038-1022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-463-8539
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2006