Provider First Line Business Practice Location Address:
137 N ALTA VISTA BLVD
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:
90036-2825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-850-2893
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2006