Provider First Line Business Practice Location Address:
633 SO. LA BREA 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:
90036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-575-9023
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2006