Provider First Line Business Practice Location Address:
425 S FAIRFAX AVE
Provider Second Line Business Practice Location Address:
STE 225
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90036-3541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-601-1024
Provider Business Practice Location Address Fax Number:
323-328-1735
Provider Enumeration Date:
02/19/2009