Provider First Line Business Practice Location Address:
928 W 40TH PL
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:
90037-1905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-235-6229
Provider Business Practice Location Address Fax Number:
323-235-1157
Provider Enumeration Date:
11/01/2006