Provider First Line Business Practice Location Address:
2614 CRENSHAW BLVD
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:
90016-3057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-230-5574
Provider Business Practice Location Address Fax Number:
323-298-7141
Provider Enumeration Date:
01/22/2010