Provider First Line Business Practice Location Address:
5012 S LA BREA AVE
Provider Second Line Business Practice Location Address:
SUITES 3 &5
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90056-1863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-298-3024
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2007