Provider First Line Business Practice Location Address:
1985 ZONAL AVENUE
Provider Second Line Business Practice Location Address:
PSC 106B
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-442-1345
Provider Business Practice Location Address Fax Number:
323-442-6815
Provider Enumeration Date:
03/29/2006