Provider First Line Business Practice Location Address:
548 S KINGSLEY DR
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:
90020-3506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-383-3303
Provider Business Practice Location Address Fax Number:
213-384-1772
Provider Enumeration Date:
04/16/2007