Provider First Line Business Practice Location Address:
801 S SPAULDING 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:
90036-4607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-923-4628
Provider Business Practice Location Address Fax Number:
323-857-1718
Provider Enumeration Date:
05/06/2009