Provider First Line Business Practice Location Address:
12655 W WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90066-2307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-967-6072
Provider Business Practice Location Address Fax Number:
310-397-6346
Provider Enumeration Date:
09/28/2006