Provider First Line Business Practice Location Address:
5710 W MANCHESTER AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90045-4423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-338-9131
Provider Business Practice Location Address Fax Number:
310-338-9129
Provider Enumeration Date:
06/27/2007