Provider First Line Business Practice Location Address:
624 W 85TH ST
Provider Second Line Business Practice Location Address:
SU. 2
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90044-5860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-222-1115
Provider Business Practice Location Address Fax Number:
323-455-0480
Provider Enumeration Date:
06/30/2008