Provider First Line Business Practice Location Address:
531 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:
90004-1305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-462-7574
Provider Business Practice Location Address Fax Number:
323-462-7156
Provider Enumeration Date:
02/15/2010