Provider First Line Business Practice Location Address:
12021 S. WILMINGTON 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:
90059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-427-5363
Provider Business Practice Location Address Fax Number:
562-427-8802
Provider Enumeration Date:
10/26/2006