Provider First Line Business Practice Location Address:
9014 S BROADWAY
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:
90003-3631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-755-1155
Provider Business Practice Location Address Fax Number:
323-777-3102
Provider Enumeration Date:
07/04/2006