Provider First Line Business Practice Location Address:
2347 EDGEWATER TER
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:
90039-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-944-0101
Provider Business Practice Location Address Fax Number:
323-944-0137
Provider Enumeration Date:
11/18/2008