Provider First Line Business Practice Location Address:
909 LUCILE 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:
90026-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-663-8281
Provider Business Practice Location Address Fax Number:
323-666-0095
Provider Enumeration Date:
10/11/2005