Provider First Line Business Practice Location Address:
3075 WILSHIRE BLVD., 8TH FL.
Provider Second Line Business Practice Location Address:
DEPT OF MENTAL HEALTH-SFC,
Provider Business Practice Location Address City Name:
LA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-717-6603
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/24/2007