Provider First Line Business Practice Location Address:
10220 S WESTERN 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:
90047-4258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-757-1744
Provider Business Practice Location Address Fax Number:
323-757-3818
Provider Enumeration Date:
11/16/2006