Provider First Line Business Practice Location Address:
12095 W WASHINGTON 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:
90066-2626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-391-5238
Provider Business Practice Location Address Fax Number:
310-391-0359
Provider Enumeration Date:
08/04/2006