Provider First Line Business Practice Location Address:
1159 S LORENA 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:
90023-2926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-881-6465
Provider Business Practice Location Address Fax Number:
323-261-8768
Provider Enumeration Date:
01/05/2007