Provider First Line Business Practice Location Address:
1710 S BURNSIDE 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:
90019-5136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-346-2630
Provider Business Practice Location Address Fax Number:
213-351-0769
Provider Enumeration Date:
07/24/2008