Provider First Line Business Practice Location Address:
587 N NEW HAMPSHIRE 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:
90004-2136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-807-1046
Provider Business Practice Location Address Fax Number:
818-361-6427
Provider Enumeration Date:
02/15/2007