Provider First Line Business Practice Location Address:
12732 WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90066-2378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-306-3737
Provider Business Practice Location Address Fax Number:
310-306-2928
Provider Enumeration Date:
02/12/2007