Provider First Line Business Practice Location Address:
2436 FEDERAL AVE
Provider Second Line Business Practice Location Address:
# 1
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90064-2960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-395-3668
Provider Business Practice Location Address Fax Number:
310-395-3668
Provider Enumeration Date:
07/13/2007