Provider First Line Business Practice Location Address:
4905 YORK BLVD
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:
90042-2022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-968-9192
Provider Business Practice Location Address Fax Number:
310-575-9822
Provider Enumeration Date:
09/27/2007