Provider First Line Business Practice Location Address:
833 N LAS PALMAS 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:
90038-3515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-773-0474
Provider Business Practice Location Address Fax Number:
225-269-8284
Provider Enumeration Date:
05/18/2006