Provider First Line Business Practice Location Address:
400 HAUSER BLVD.
Provider Second Line Business Practice Location Address:
#3B
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-503-9150
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2012