Provider First Line Business Practice Location Address:
6214 DREXEL 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:
90048-4702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-934-9628
Provider Business Practice Location Address Fax Number:
323-938-9209
Provider Enumeration Date:
03/18/2007