Provider First Line Business Practice Location Address:
1836 ASHMORE PL
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:
90026-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-532-0123
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2012