Provider First Line Business Practice Location Address:
2001 W 48TH ST
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:
90062-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-299-4649
Provider Business Practice Location Address Fax Number:
323-299-4651
Provider Enumeration Date:
11/19/2007