Provider First Line Business Practice Location Address:
7120 FRANKLIN 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:
90046-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-876-0551
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2011