Provider First Line Business Practice Location Address:
3061 WABASH 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:
90063-2765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-788-8787
Provider Business Practice Location Address Fax Number:
818-788-9010
Provider Enumeration Date:
06/10/2009