Provider First Line Business Practice Location Address:
1011 GOODRICH BLVD.
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:
90022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-888-9191
Provider Business Practice Location Address Fax Number:
323-888-9287
Provider Enumeration Date:
02/20/2007