Provider First Line Business Practice Location Address:
2818 LA CIENEGA AVE.
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-204-6444
Provider Business Practice Location Address Fax Number:
310-204-6440
Provider Enumeration Date:
10/02/2006