Provider First Line Business Practice Location Address:
947 S RIDGELEY DR
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:
90036-4705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-965-1365
Provider Business Practice Location Address Fax Number:
785-955-6014
Provider Enumeration Date:
09/01/2014