Provider First Line Business Practice Location Address:
4316 1/2 NORMAL 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:
90029-2705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-999-1194
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/06/2014