Provider First Line Business Practice Location Address:
4602 CRENSHAW BLVD
Provider Second Line Business Practice Location Address:
SUITE 2C
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90043-1219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-296-1385
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2006