Provider First Line Business Practice Location Address:
609 N MEDNIK 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:
90022-1326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-268-9979
Provider Business Practice Location Address Fax Number:
323-268-9539
Provider Enumeration Date:
09/12/2006