Provider First Line Business Practice Location Address:
4170 VERDUGO RD
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:
90065-3821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-257-5115
Provider Business Practice Location Address Fax Number:
323-256-2695
Provider Enumeration Date:
03/29/2013