Provider First Line Business Practice Location Address:
5926 MONTEREY RD
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:
90042-4943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-503-1414
Provider Business Practice Location Address Fax Number:
323-967-4415
Provider Enumeration Date:
04/27/2015