Provider First Line Business Practice Location Address:
179 S BARRINGTON PL
Provider Second Line Business Practice Location Address:
STE. B
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90049-3305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-491-1472
Provider Business Practice Location Address Fax Number:
714-739-4008
Provider Enumeration Date:
09/30/2011