Provider First Line Business Practice Location Address:
8615 S BROADWAY
Provider Second Line Business Practice Location Address:
KLEINMAN & WALLACE PROF DENTAL CORP
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-752-3116
Provider Business Practice Location Address Fax Number:
323-752-7203
Provider Enumeration Date:
11/06/2006