Provider First Line Business Practice Location Address:
2437 S HALM 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:
90034-2028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-837-4354
Provider Business Practice Location Address Fax Number:
310-837-1533
Provider Enumeration Date:
11/21/2006