Provider First Line Business Practice Location Address:
1721 GRIFFIN 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:
90031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-226-3961
Provider Business Practice Location Address Fax Number:
323-221-3328
Provider Enumeration Date:
05/11/2007