Provider First Line Business Practice Location Address:
820 S OGDEN DR
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:
90036-4414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-938-0262
Provider Business Practice Location Address Fax Number:
323-938-0308
Provider Enumeration Date:
09/16/2009