Provider First Line Business Practice Location Address:
1835 S LA CIENEGA BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90035-4600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-287-3711
Provider Business Practice Location Address Fax Number:
310-287-3717
Provider Enumeration Date:
04/27/2016