Provider First Line Business Practice Location Address:
SUD SPECIALTY GROUP - CA
Provider Second Line Business Practice Location Address:
4470 W. SUNSET BLVD, STE 107
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-205-7088
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2020