Provider First Line Business Practice Location Address:
3721 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:
90016-5309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-730-1920
Provider Business Practice Location Address Fax Number:
323-373-2045
Provider Enumeration Date:
10/16/2006