Provider First Line Business Practice Location Address:
9909 COMPTON 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:
90002-2850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-564-3218
Provider Business Practice Location Address Fax Number:
323-564-4064
Provider Enumeration Date:
10/06/2005