Provider First Line Business Practice Location Address:
3148 BUTLER 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:
90066-1302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-927-7206
Provider Business Practice Location Address Fax Number:
208-439-1055
Provider Enumeration Date:
06/04/2007