Provider First Line Business Practice Location Address:
617 W. MANCHESTER 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:
90044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-375-4944
Provider Business Practice Location Address Fax Number:
888-534-5766
Provider Enumeration Date:
11/27/2007