Provider First Line Business Practice Location Address:
4616 WELCH PL #3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-924-2096
Provider Business Practice Location Address Fax Number:
323-668-2472
Provider Enumeration Date:
07/11/2011