Provider First Line Business Practice Location Address:
370 S FAIRFAX AVE
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:
90036-3138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-852-6900
Provider Business Practice Location Address Fax Number:
323-852-6904
Provider Enumeration Date:
10/12/2006