Provider First Line Business Practice Location Address:
469 S. HOLT AVENUE
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:
90048-0469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-547-7911
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2007