Provider First Line Business Practice Location Address:
4730 S EASTERN 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:
90040-2913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-728-9078
Provider Business Practice Location Address Fax Number:
714-899-4275
Provider Enumeration Date:
04/03/2007