Provider First Line Business Practice Location Address:
9624 COMPTON 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:
90002-2333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-567-9883
Provider Business Practice Location Address Fax Number:
323-567-9885
Provider Enumeration Date:
05/01/2009