Provider First Line Business Practice Location Address:
11859 COMPTON 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:
90059-2958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-563-1140
Provider Business Practice Location Address Fax Number:
323-566-5253
Provider Enumeration Date:
11/17/2006