Provider First Line Business Practice Location Address:
5801 E BEVERLY 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:
90022-2805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-722-4529
Provider Business Practice Location Address Fax Number:
323-722-4450
Provider Enumeration Date:
07/24/2012