Provider First Line Business Practice Location Address:
2051 MARENGO ST
Provider Second Line Business Practice Location Address:
C3C162
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-1352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-409-3094
Provider Business Practice Location Address Fax Number:
323-441-8390
Provider Enumeration Date:
04/08/2010