Provider First Line Business Practice Location Address:
6057 1/2 SELMA 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:
90028-6414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-245-4153
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2007