Provider First Line Business Practice Location Address:
622 SAN PASCUAL 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:
90042-3838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-487-9800
Provider Business Practice Location Address Fax Number:
213-487-9801
Provider Enumeration Date:
10/07/2008