Provider First Line Business Practice Location Address:
2625 MAPLE AVENUE
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:
90011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-747-6371
Provider Business Practice Location Address Fax Number:
213-747-1615
Provider Enumeration Date:
09/13/2005