Provider First Line Business Practice Location Address:
2238 S CARMELINA 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:
90064-1077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-470-3365
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2011