Provider First Line Business Practice Location Address:
1260 S SOTO ST
Provider Second Line Business Practice Location Address:
UNIT 3
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90023-2631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-262-5600
Provider Business Practice Location Address Fax Number:
323-262-5700
Provider Enumeration Date:
05/24/2007