Provider First Line Business Practice Location Address:
4837 HUNTINGTON DR N STE 1
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:
90032-1953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-225-0024
Provider Business Practice Location Address Fax Number:
323-225-0023
Provider Enumeration Date:
10/16/2006