Provider First Line Business Practice Location Address:
3119 GLENDALE BLVD
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:
90039-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-660-5186
Provider Business Practice Location Address Fax Number:
323-660-3798
Provider Enumeration Date:
05/10/2007