Provider First Line Business Practice Location Address:
6711 MELROSE 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:
90038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-307-7220
Provider Business Practice Location Address Fax Number:
213-403-4685
Provider Enumeration Date:
08/19/2015