Provider First Line Business Practice Location Address: 
3751 STOCKER ST
    Provider Second Line Business Practice Location Address: 
WEST CENTRAL MENTAL HEALTH
    Provider Business Practice Location Address City Name: 
LOS ANGELES
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
90008-5101
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
323-298-3680
    Provider Business Practice Location Address Fax Number: 
323-292-0053
    Provider Enumeration Date: 
11/03/2006