Provider First Line Business Practice Location Address:
6513 HOLLYWOOD BLVD
Provider Second Line Business Practice Location Address:
STE 213
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90028-6251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-466-4400
Provider Business Practice Location Address Fax Number:
323-786-8601
Provider Enumeration Date:
04/10/2011