Provider First Line Business Practice Location Address:
4732 E 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90022-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-261-5424
Provider Business Practice Location Address Fax Number:
323-261-5200
Provider Enumeration Date:
01/03/2007