Provider First Line Business Practice Location Address:
2001 SO BARRINGTON AVENUE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-477-8190
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2007