Provider First Line Business Practice Location Address:
6606 W 5TH 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:
90048-4602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-435-4806
Provider Business Practice Location Address Fax Number:
323-653-6332
Provider Enumeration Date:
08/24/2006