Provider First Line Business Practice Location Address:
4708 CRENSHAW BLVD
Provider Second Line Business Practice Location Address:
SUITE 101-105
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90043-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-293-9722
Provider Business Practice Location Address Fax Number:
323-293-9722
Provider Enumeration Date:
07/25/2007