Provider First Line Business Practice Location Address:
5059 YORK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90042-1713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-344-4144
Provider Business Practice Location Address Fax Number:
323-344-4146
Provider Enumeration Date:
10/02/2009