Provider First Line Business Practice Location Address:
6301 S WESTERN AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90047-1451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-750-9120
Provider Business Practice Location Address Fax Number:
323-750-9130
Provider Enumeration Date:
10/17/2006