Provider First Line Business Practice Location Address:
1910 MAGNOLIA 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:
90007-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-749-0947
Provider Business Practice Location Address Fax Number:
213-749-7354
Provider Enumeration Date:
02/06/2007