Provider First Line Business Practice Location Address:
2150 HILLHURST 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:
90027-2012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-465-5707
Provider Business Practice Location Address Fax Number:
313-432-6019
Provider Enumeration Date:
06/15/2026