Provider First Line Business Practice Location Address:
4104 1/2 VERDUGO RD
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:
90065-3821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-474-6035
Provider Business Practice Location Address Fax Number:
323-474-6104
Provider Enumeration Date:
01/27/2017