Provider First Line Business Practice Location Address:
12720 W WASHINGTON 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:
90066-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-823-6733
Provider Business Practice Location Address Fax Number:
310-823-6973
Provider Enumeration Date:
10/30/2008