Provider First Line Business Practice Location Address:
8631 W 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 1015E
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90048-5901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-652-4472
Provider Business Practice Location Address Fax Number:
310-358-2266
Provider Enumeration Date:
02/14/2007