Provider First Line Business Practice Location Address:
4369 S VAN NESS AVE
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:
90062-1454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-292-3558
Provider Business Practice Location Address Fax Number:
323-292-3688
Provider Enumeration Date:
06/03/2008