Provider First Line Business Practice Location Address:
1623 S. LA CIENEGA 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:
90272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-246-1918
Provider Business Practice Location Address Fax Number:
310-248-2723
Provider Enumeration Date:
07/21/2011