Provider First Line Business Practice Location Address:
4833 10TH 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:
90043-4810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-220-5613
Provider Business Practice Location Address Fax Number:
323-375-3217
Provider Enumeration Date:
10/13/2008