Provider First Line Business Practice Location Address:
2252 BEVERLY BLVD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-2225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-387-6453
Provider Business Practice Location Address Fax Number:
213-387-5390
Provider Enumeration Date:
07/27/2006