Provider First Line Business Practice Location Address:
1071 S LUCERNE 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:
90019-6812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-932-1823
Provider Business Practice Location Address Fax Number:
818-760-6542
Provider Enumeration Date:
10/27/2006