Provider First Line Business Practice Location Address:
4326 S WESTERN 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:
90062-1648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-299-9914
Provider Business Practice Location Address Fax Number:
213-292-3254
Provider Enumeration Date:
07/28/2006