Provider First Line Business Practice Location Address:
5007 MELROSE 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:
90038-4106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-462-4030
Provider Business Practice Location Address Fax Number:
323-462-4031
Provider Enumeration Date:
11/08/2007