Provider First Line Business Practice Location Address:
562 N LARCHMONT BLVD
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:
90004-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-446-8658
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2007