Provider First Line Business Practice Location Address:
601 MICHOLETORENA 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:
90026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-213-0581
Provider Business Practice Location Address Fax Number:
213-213-0580
Provider Enumeration Date:
06/15/2011