Provider First Line Business Practice Location Address:
5014 HUNTINGTON DR SOUTH
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:
90032-1698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-222-2362
Provider Business Practice Location Address Fax Number:
323-225-4171
Provider Enumeration Date:
12/14/2006