Provider First Line Business Practice Location Address:
1344 1/2 N EDGEMONT ST
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:
90027-5912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-873-3576
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2012