Provider First Line Business Practice Location Address:
3640 MCKENZIE 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:
90032-1424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-562-4567
Provider Business Practice Location Address Fax Number:
323-887-1891
Provider Enumeration Date:
05/08/2007