Provider First Line Business Practice Location Address:
1233 S 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:
90035-2520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-855-0031
Provider Business Practice Location Address Fax Number:
310-855-0138
Provider Enumeration Date:
06/24/2010