Provider First Line Business Practice Location Address:
1249 S LA BREA AVE
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:
90019-1627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-931-4647
Provider Business Practice Location Address Fax Number:
323-931-4748
Provider Enumeration Date:
03/28/2013