Provider First Line Business Practice Location Address:
456 S MATHEWS 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:
90033-4326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-780-6502
Provider Business Practice Location Address Fax Number:
323-780-6685
Provider Enumeration Date:
08/22/2008