Provider First Line Business Practice Location Address:
11805 WASHINGTON BLVD.
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:
90066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-390-9549
Provider Business Practice Location Address Fax Number:
310-572-1522
Provider Enumeration Date:
01/20/2012