Provider First Line Business Practice Location Address:
3006 S NORTON 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:
90018-3238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-737-3629
Provider Business Practice Location Address Fax Number:
323-737-3710
Provider Enumeration Date:
03/20/2006