Provider First Line Business Practice Location Address:
3531 FEDERAL 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:
90066-2810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-343-4911
Provider Business Practice Location Address Fax Number:
714-771-8481
Provider Enumeration Date:
12/20/2007