Provider First Line Business Practice Location Address:
8281 MELROSE AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90046-6832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-386-6404
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2006