Provider First Line Business Practice Location Address:
2131 W 3RD 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:
90057-1901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-471-5852
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2007