Provider First Line Business Practice Location Address:
1050 N HIGHLAND 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:
90038-2407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-463-1692
Provider Business Practice Location Address Fax Number:
323-463-4351
Provider Enumeration Date:
06/02/2011