Provider First Line Business Practice Location Address:
1240 N MISSION 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:
90033-1019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-226-3691
Provider Business Practice Location Address Fax Number:
323-226-5692
Provider Enumeration Date:
07/06/2007