Provider First Line Business Practice Location Address:
815 W CESAR CHAVEZ AVE.
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90012-2113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-447-0290
Provider Business Practice Location Address Fax Number:
213-613-0680
Provider Enumeration Date:
07/31/2015