Provider First Line Business Practice Location Address:
7316 COMPTON 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:
90001-2532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-586-9828
Provider Business Practice Location Address Fax Number:
323-589-2174
Provider Enumeration Date:
10/30/2009