Provider First Line Business Practice Location Address:
6106 S LA BREA AVE
Provider Second Line Business Practice Location Address:
SAME AS ABOVE
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90056-1822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-299-9604
Provider Business Practice Location Address Fax Number:
323-298-9605
Provider Enumeration Date:
06/04/2008