Provider First Line Business Practice Location Address:
5849 CROCKER ST
Provider Second Line Business Practice Location Address:
UNIT K
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90003-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-406-5800
Provider Business Practice Location Address Fax Number:
323-233-2685
Provider Enumeration Date:
03/23/2007