Provider First Line Business Practice Location Address:
7700 BRIGHTON 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:
90047-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-778-7208
Provider Business Practice Location Address Fax Number:
323-778-9835
Provider Enumeration Date:
11/26/2013