Provider First Line Business Practice Location Address:
1662 S ORANGE GROVE 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:
90019-4933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-668-5151
Provider Business Practice Location Address Fax Number:
310-223-0695
Provider Enumeration Date:
10/18/2006