Provider First Line Business Practice Location Address:
4216 BEVERLY 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:
90004-4430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-382-8899
Provider Business Practice Location Address Fax Number:
213-382-8830
Provider Enumeration Date:
12/11/2010