Provider First Line Business Practice Location Address:
316 NORTH ROSSMORE AVENUE
Provider Second Line Business Practice Location Address:
SUITE 507
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90004-2415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-466-7333
Provider Business Practice Location Address Fax Number:
323-871-1696
Provider Enumeration Date:
04/20/2010