Provider First Line Business Practice Location Address:
903 S CRENSHAW BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90019-1965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-954-0145
Provider Business Practice Location Address Fax Number:
323-954-0270
Provider Enumeration Date:
07/10/2006