Provider First Line Business Practice Location Address:
1425 W MANCHESTER AVE
Provider Second Line Business Practice Location Address:
A
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90047-5439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-309-1244
Provider Business Practice Location Address Fax Number:
323-750-9700
Provider Enumeration Date:
09/29/2010