Provider First Line Business Practice Location Address:
714 1/2 N EDINBURGH 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:
90046-7004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-492-5014
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2009