Provider First Line Business Practice Location Address:
12331 W WASHINGTON BLVD
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:
90066-5509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-398-5733
Provider Business Practice Location Address Fax Number:
310-313-6740
Provider Enumeration Date:
07/06/2006