Provider First Line Business Practice Location Address:
1531 PURDUE 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:
90025-3104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-473-1885
Provider Business Practice Location Address Fax Number:
323-658-7523
Provider Enumeration Date:
07/10/2006