Provider First Line Business Practice Location Address:
8635 W 3RD ST
Provider Second Line Business Practice Location Address:
STE 485W
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90048-6101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-652-9162
Provider Business Practice Location Address Fax Number:
310-854-7259
Provider Enumeration Date:
07/12/2006