Provider First Line Business Practice Location Address:
149 S BARRINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 196
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90049-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-526-1111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2012