Provider First Line Business Practice Location Address:
151 S MEDNIK 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:
90022-1606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-384-0832
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2007