Provider First Line Business Practice Location Address:
4908 BUCHANAN ST
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-540-4336
Provider Business Practice Location Address Fax Number:
415-503-6099
Provider Enumeration Date:
12/27/2007