Provider First Line Business Practice Location Address:
1121 W KENSINGTON 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:
90026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-559-1975
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2012