Provider First Line Business Practice Location Address:
739 N FAIRFAX 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:
90046-7261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-655-3933
Provider Business Practice Location Address Fax Number:
323-655-9725
Provider Enumeration Date:
08/12/2006