Provider First Line Business Practice Location Address:
241 W 118TH PL
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:
90061-1750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-685-5818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2009