Provider First Line Business Practice Location Address:
359 E EDGEWARE RD
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:
90026-5669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-482-1487
Provider Business Practice Location Address Fax Number:
213-481-2097
Provider Enumeration Date:
01/26/2010