Provider First Line Business Practice Location Address:
ST. JOHN'S WELL CHILD
Provider Second Line Business Practice Location Address:
1910 MAGNOLIA AVE #101
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-749-0947
Provider Business Practice Location Address Fax Number:
213-749-7354
Provider Enumeration Date:
03/22/2016