Provider First Line Business Practice Location Address:
6630 S VAN NESS 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:
90047-1650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-565-2043
Provider Business Practice Location Address Fax Number:
323-565-2044
Provider Enumeration Date:
05/01/2007