Provider First Line Business Practice Location Address:
7006 S WESTERN 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:
90047-1843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-750-1435
Provider Business Practice Location Address Fax Number:
323-750-5923
Provider Enumeration Date:
03/23/2009