Provider First Line Business Practice Location Address:
4448 YORK 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:
90041-3328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-702-4856
Provider Business Practice Location Address Fax Number:
323-344-5237
Provider Enumeration Date:
12/28/2007