Provider First Line Business Practice Location Address:
1825 N WESTERN 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:
90027-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-461-4279
Provider Business Practice Location Address Fax Number:
323-461-4279
Provider Enumeration Date:
01/08/2007