Provider First Line Business Practice Location Address:
2217 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:
90033-3966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-264-4466
Provider Business Practice Location Address Fax Number:
323-264-4383
Provider Enumeration Date:
07/23/2008