Provider First Line Business Practice Location Address:
1710 N MCCADDEN PL
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:
90028-4603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-461-1990
Provider Business Practice Location Address Fax Number:
323-461-1995
Provider Enumeration Date:
10/22/2013