Provider First Line Business Practice Location Address:
5012 S LA BREA AVE STE 2
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:
90056-1863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-290-0200
Provider Business Practice Location Address Fax Number:
323-290-0202
Provider Enumeration Date:
04/06/2011