Provider First Line Business Practice Location Address:
1137 1/2 CARDIFF 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:
90035-1355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-447-7095
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2012