Provider First Line Business Practice Location Address:
1331 N CORONADO ST
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:
90026-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-896-1161
Provider Business Practice Location Address Fax Number:
818-896-5069
Provider Enumeration Date:
08/10/2009