Provider First Line Business Practice Location Address:
12112 W WASHINGTON BLVD # 100
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:
90066-5514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-398-0636
Provider Business Practice Location Address Fax Number:
310-398-0546
Provider Enumeration Date:
02/12/2007