Provider First Line Business Practice Location Address:
4562 E CESAR E CHAVEZ 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:
90022-1117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-796-0250
Provider Business Practice Location Address Fax Number:
323-796-0251
Provider Enumeration Date:
06/11/2006