Provider First Line Business Practice Location Address:
1530 GREENFIELD 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:
90025-3416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-479-1143
Provider Business Practice Location Address Fax Number:
310-455-2727
Provider Enumeration Date:
04/26/2013