Provider First Line Business Practice Location Address:
1832 W SUNSET 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:
90026-3227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-413-1255
Provider Business Practice Location Address Fax Number:
213-413-2843
Provider Enumeration Date:
09/01/2006