Provider First Line Business Practice Location Address:
4655 KINGSWELL AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027-4348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-662-2195
Provider Business Practice Location Address Fax Number:
323-913-3895
Provider Enumeration Date:
05/25/2007