Provider First Line Business Practice Location Address:
1151 NORTH AVENUE 53
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:
90042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-821-8023
Provider Business Practice Location Address Fax Number:
818-804-4047
Provider Enumeration Date:
05/23/2007