Provider First Line Business Practice Location Address:
6226 1 HALF WEST MANCHESTER AVE.
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:
90045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-215-9156
Provider Business Practice Location Address Fax Number:
310-215-3479
Provider Enumeration Date:
05/15/2007