Provider First Line Business Practice Location Address:
115 S KENMORE AVE
Provider Second Line Business Practice Location Address:
APT #6
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90004-5646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-902-3827
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2009