Provider First Line Business Practice Location Address:
1537 S SHENANDOAH ST
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:
90035-4480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-735-4356
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2009