Provider First Line Business Practice Location Address:
3870 S CRENSHAW BLVD
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90008-1815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-295-5359
Provider Business Practice Location Address Fax Number:
323-292-9492
Provider Enumeration Date:
03/01/2007