Provider First Line Business Practice Location Address:
4607 HUNTINGTON DR N
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:
90032-1919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-227-9885
Provider Business Practice Location Address Fax Number:
323-227-9897
Provider Enumeration Date:
12/04/2006