Provider First Line Business Practice Location Address:
2126 S LA BREA AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90016-2277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-549-3420
Provider Business Practice Location Address Fax Number:
323-375-1341
Provider Enumeration Date:
06/06/2006