Provider First Line Business Practice Location Address:
4324 W JEFFERSON BLVD
Provider Second Line Business Practice Location Address:
CRENSHAW SEA
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90016-4115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-735-6018
Provider Business Practice Location Address Fax Number:
323-735-6966
Provider Enumeration Date:
04/24/2007