Provider First Line Business Practice Location Address:
3225 FLUNTER ST
Provider Second Line Business Practice Location Address:
ESTRADA COURTS SEA
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-881-6762
Provider Business Practice Location Address Fax Number:
323-881-9591
Provider Enumeration Date:
04/24/2007