Provider First Line Business Practice Location Address:
4350 11TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-292-2898
Provider Business Practice Location Address Fax Number:
323-292-2126
Provider Enumeration Date:
09/12/2006