Provider First Line Business Practice Location Address:
4901 YORK BLVD
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:
90042-1609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-478-1515
Provider Business Practice Location Address Fax Number:
323-254-6622
Provider Enumeration Date:
03/02/2007