Provider First Line Business Practice Location Address:
865 COMSTOCK AVE
Provider Second Line Business Practice Location Address:
UNIT 3B
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90024-2572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-512-5575
Provider Business Practice Location Address Fax Number:
310-275-0832
Provider Enumeration Date:
01/28/2012