Provider First Line Business Practice Location Address:
5400 HOLLYWOOD BLVD UNIT A
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:
90027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-664-6664
Provider Business Practice Location Address Fax Number:
866-247-6679
Provider Enumeration Date:
02/15/2011