Provider First Line Business Practice Location Address:
5420 N FIGUEROA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90042-4118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-999-2414
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2008