Provider First Line Business Practice Location Address:
3655 E 3RD 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:
90063-2441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-263-3804
Provider Business Practice Location Address Fax Number:
323-263-3875
Provider Enumeration Date:
06/12/2006