Provider First Line Business Practice Location Address:
435 N LARCHMONT BLVD
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:
90004-3043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-462-4710
Provider Business Practice Location Address Fax Number:
213-254-9034
Provider Enumeration Date:
11/16/2006