Provider First Line Business Practice Location Address:
4728 S WESTERN 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:
90062-2320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-293-7388
Provider Business Practice Location Address Fax Number:
323-293-7805
Provider Enumeration Date:
06/30/2008