Provider First Line Business Practice Location Address:
680 S CLOVERDALE 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:
90036-4104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-938-7237
Provider Business Practice Location Address Fax Number:
323-938-7011
Provider Enumeration Date:
07/08/2010