Provider First Line Business Practice Location Address:
2000 LAUREL CANYON BLVD. #2
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:
90046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-806-0638
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2007