Provider First Line Business Practice Location Address:
1619 AND A HALF WEST PICO 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:
90015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-487-0615
Provider Business Practice Location Address Fax Number:
213-381-2251
Provider Enumeration Date:
03/26/2007