Provider First Line Business Practice Location Address:
3791 S CENTINELA 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:
90066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-391-0699
Provider Business Practice Location Address Fax Number:
310-391-6990
Provider Enumeration Date:
12/18/2006