Provider First Line Business Practice Location Address:
13110 W 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:
90066-5126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-273-8616
Provider Business Practice Location Address Fax Number:
310-273-8282
Provider Enumeration Date:
11/09/2006