Provider First Line Business Practice Location Address:
5222 WASHINGTON BLVD.
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:
90016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-421-7110
Provider Business Practice Location Address Fax Number:
818-450-1460
Provider Enumeration Date:
09/23/2014