Provider First Line Business Practice Location Address:
5418 DEANE 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:
90043-2315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-335-3049
Provider Business Practice Location Address Fax Number:
323-298-3012
Provider Enumeration Date:
05/23/2013