Provider First Line Business Practice Location Address:
1100 W MANCHESTER AVE
Provider Second Line Business Practice Location Address:
MANCHESTER SEA
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90044-3430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-789-5760
Provider Business Practice Location Address Fax Number:
323-750-7337
Provider Enumeration Date:
04/24/2007