Provider First Line Business Practice Location Address:
3881 S. 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:
90062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-290-4346
Provider Business Practice Location Address Fax Number:
323-293-8159
Provider Enumeration Date:
02/14/2007