Provider First Line Business Practice Location Address:
1016 S RECORD AVE
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:
90023-2533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-268-0106
Provider Business Practice Location Address Fax Number:
323-268-2010
Provider Enumeration Date:
06/22/2005