Provider First Line Business Practice Location Address:
3496 FEDERAL 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:
90066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-398-2818
Provider Business Practice Location Address Fax Number:
310-397-1613
Provider Enumeration Date:
10/18/2006