Provider First Line Business Practice Location Address:
1240 N MISSION RD
Provider Second Line Business Practice Location Address:
L919
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-1019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-226-3369
Provider Business Practice Location Address Fax Number:
323-226-3440
Provider Enumeration Date:
03/28/2007