Provider First Line Business Practice Location Address:
3015 CRENSHAW BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90016-4264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-734-1534
Provider Business Practice Location Address Fax Number:
323-734-4693
Provider Enumeration Date:
11/05/2008