Provider First Line Business Practice Location Address:
1857 S HAYWORTH 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:
90035-4619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-935-2244
Provider Business Practice Location Address Fax Number:
323-939-1069
Provider Enumeration Date:
04/25/2007