Provider First Line Business Practice Location Address:
6046 S CHARITON 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:
90056-1508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-412-4883
Provider Business Practice Location Address Fax Number:
310-641-0308
Provider Enumeration Date:
07/01/2014