Provider First Line Business Practice Location Address:
1320 N HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90028-7609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-856-4247
Provider Business Practice Location Address Fax Number:
323-460-2035
Provider Enumeration Date:
11/01/2007