Provider First Line Business Practice Location Address:
1474 S CANFIELD 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:
90035-3223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-621-5330
Provider Business Practice Location Address Fax Number:
310-557-3417
Provider Enumeration Date:
01/18/2007