Provider First Line Business Practice Location Address:
2550 BEVERLY BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-1035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-388-5847
Provider Business Practice Location Address Fax Number:
213-388-5848
Provider Enumeration Date:
08/17/2006