Provider First Line Business Practice Location Address:
1551 WALDRAN 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-326-7790
Provider Business Practice Location Address Fax Number:
323-258-2811
Provider Enumeration Date:
06/15/2010