Provider First Line Business Practice Location Address:
251 S MEDNIK 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:
90022-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-264-8799
Provider Business Practice Location Address Fax Number:
323-264-4536
Provider Enumeration Date:
05/27/2006