Provider First Line Business Practice Location Address:
124 N 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:
90036-2912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-922-2252
Provider Business Practice Location Address Fax Number:
818-301-5156
Provider Enumeration Date:
11/08/2007