Provider First Line Business Practice Location Address:
260 S LA BREA 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:
90036-3023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-937-9383
Provider Business Practice Location Address Fax Number:
323-937-9916
Provider Enumeration Date:
07/13/2006