Provider First Line Business Practice Location Address:
12202 WEST WASHINGTON BLVD
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:
90066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-915-9797
Provider Business Practice Location Address Fax Number:
310-915-9739
Provider Enumeration Date:
12/05/2006