Provider First Line Business Practice Location Address:
1253 GRANVILLE AVE
Provider Second Line Business Practice Location Address:
UNIT #5
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-1693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-231-0050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2007