Provider First Line Business Practice Location Address:
616 N 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:
90063-1838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-273-1903
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2009