Provider First Line Business Practice Location Address:
8022 MELROSE AVE
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:
213-221-0552
Provider Business Practice Location Address Fax Number:
213-906-0079
Provider Enumeration Date:
06/17/2014