Provider First Line Business Practice Location Address:
11080 W OLYMPIC BLVD
Provider Second Line Business Practice Location Address:
EDELMAN CHILDRENS MHC 1ST FL
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-966-6610
Provider Business Practice Location Address Fax Number:
310-231-0760
Provider Enumeration Date:
11/20/2006