Provider First Line Business Practice Location Address:
2209 N SAN FERNANDO RD
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:
90065-1231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-226-0511
Provider Business Practice Location Address Fax Number:
323-221-5247
Provider Enumeration Date:
07/10/2008