Provider First Line Business Practice Location Address:
420 1/2 N LARCHMONT BLVD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90004-3014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-800-1442
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/27/2012