Provider First Line Business Practice Location Address:
1848 MIDDLETON PL
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:
90062-1037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-293-7545
Provider Business Practice Location Address Fax Number:
323-293-7545
Provider Enumeration Date:
04/25/2009