Provider First Line Business Practice Location Address:
1225 S KENMORE 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:
90006-3316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-388-3379
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2007