Provider First Line Business Practice Location Address:
1950 SAWTELLE BLVD
Provider Second Line Business Practice Location Address:
SUITE 145 A
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-7014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-481-2245
Provider Business Practice Location Address Fax Number:
310-481-2226
Provider Enumeration Date:
07/03/2006