Provider First Line Business Practice Location Address:
7266 FRANKLIN AVE
Provider Second Line Business Practice Location Address:
APT 106
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90046-3021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-351-1072
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2014