Provider First Line Business Practice Location Address:
7121 W MANCHESTER 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:
90045-3508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-750-9789
Provider Business Practice Location Address Fax Number:
424-750-9791
Provider Enumeration Date:
04/11/2012