Provider First Line Business Practice Location Address:
2946 1/2 KENWOOD 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:
90007-3064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-584-8526
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2009