Provider First Line Business Practice Location Address:
449 N FLORES 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:
90048-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-651-5371
Provider Business Practice Location Address Fax Number:
323-521-5113
Provider Enumeration Date:
07/20/2006