Provider First Line Business Practice Location Address:
1627 W 20TH 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:
90007-1102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-299-8788
Provider Business Practice Location Address Fax Number:
323-299-8726
Provider Enumeration Date:
09/20/2006