Provider First Line Business Practice Location Address:
7250 FRANKLIN AVE
Provider Second Line Business Practice Location Address:
UNIT 1115
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90046-3049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-874-6966
Provider Business Practice Location Address Fax Number:
323-874-1419
Provider Enumeration Date:
10/18/2006