Provider First Line Business Practice Location Address:
2221 MANNING 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:
90064-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-474-6714
Provider Business Practice Location Address Fax Number:
310-234-4034
Provider Enumeration Date:
02/07/2007