Provider First Line Business Practice Location Address:
255 S MARIPOSA 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:
90004-5407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-639-2680
Provider Business Practice Location Address Fax Number:
213-480-6434
Provider Enumeration Date:
03/07/2007