Provider First Line Business Practice Location Address:
5870 CRENSHAW BLVD STE 512
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:
90043-2449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-292-0231
Provider Business Practice Location Address Fax Number:
323-292-0786
Provider Enumeration Date:
07/26/2007