Provider First Line Business Practice Location Address:
2236 MERTON 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:
90041-1915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-257-7518
Provider Business Practice Location Address Fax Number:
323-255-3544
Provider Enumeration Date:
12/06/2005