Provider First Line Business Practice Location Address:
1480 S LA CIENEGA 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:
90035-3715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-652-3030
Provider Business Practice Location Address Fax Number:
310-652-0329
Provider Enumeration Date:
01/26/2009