Provider First Line Business Practice Location Address:
3616 E 1ST 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:
90063-2326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-164-6157
Provider Business Practice Location Address Fax Number:
323-264-0099
Provider Enumeration Date:
04/20/2007