Provider First Line Business Practice Location Address:
6226 W MANCHESTER 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:
90045-3801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-670-1208
Provider Business Practice Location Address Fax Number:
310-670-1218
Provider Enumeration Date:
03/28/2007