Provider First Line Business Practice Location Address:
1510 N POINSETTIA PL
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:
90046-3611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-851-7140
Provider Business Practice Location Address Fax Number:
323-851-6117
Provider Enumeration Date:
03/05/2007