Provider First Line Business Practice Location Address:
4561 S CENTINELA 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:
90066-6248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-822-6354
Provider Business Practice Location Address Fax Number:
310-822-6540
Provider Enumeration Date:
02/28/2007