Provider First Line Business Practice Location Address:
245 S FETTERLY 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:
90022-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-780-2216
Provider Business Practice Location Address Fax Number:
323-264-3771
Provider Enumeration Date:
09/20/2006