Provider First Line Business Practice Location Address:
2750 W BROADWAY
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:
90041-1050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-241-3125
Provider Business Practice Location Address Fax Number:
818-241-1652
Provider Enumeration Date:
01/09/2007