Provider First Line Business Practice Location Address:
1423 GAGE AVE
Provider Second Line Business Practice Location Address:
SUITE A WEST COAST DENTAL
Provider Business Practice Location Address City Name:
LA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-198-3400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2009