Provider First Line Business Practice Location Address:
1541 CRENSHAW BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90019-4356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-937-2838
Provider Business Practice Location Address Fax Number:
323-937-2877
Provider Enumeration Date:
07/31/2006