Provider First Line Business Practice Location Address:
6542 HOLLYWOOD 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:
90028-6217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-461-3606
Provider Business Practice Location Address Fax Number:
323-461-3600
Provider Enumeration Date:
08/24/2006