Provider First Line Business Practice Location Address:
1445 N 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:
90028-7505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-798-5158
Provider Business Practice Location Address Fax Number:
323-798-4914
Provider Enumeration Date:
04/27/2012