Provider First Line Business Practice Location Address:
535 W 130TH ST
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:
90061-1180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-349-0600
Provider Business Practice Location Address Fax Number:
424-244-3034
Provider Enumeration Date:
11/10/2006