Provider First Line Business Practice Location Address:
1021 MANNING 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:
90024-3220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-474-5671
Provider Business Practice Location Address Fax Number:
310-474-3985
Provider Enumeration Date:
03/27/2009