Provider First Line Business Practice Location Address:
2417 CASTLE HEIGHTS 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:
90034-1051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-993-6656
Provider Business Practice Location Address Fax Number:
818-348-1129
Provider Enumeration Date:
07/14/2006