Provider First Line Business Practice Location Address:
970 W 42ND 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:
90037-2507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-234-0504
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2010