Provider First Line Business Practice Location Address:
414 N HARPER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-521-9692
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2010