Provider First Line Business Practice Location Address:
838 N 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:
90069-4708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-659-6351
Provider Business Practice Location Address Fax Number:
310-659-6356
Provider Enumeration Date:
04/29/2008