Provider First Line Business Practice Location Address:
3249 CASITAS AVE
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90039-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-544-1415
Provider Business Practice Location Address Fax Number:
323-843-9262
Provider Enumeration Date:
10/10/2009