Provider First Line Business Practice Location Address:
3429 CRENSHAW BLVD
Provider Second Line Business Practice Location Address:
SUITE#1
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90016-4845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-776-3011
Provider Business Practice Location Address Fax Number:
323-731-7069
Provider Enumeration Date:
11/25/2009