Provider First Line Business Practice Location Address:
1628 W 25TH 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:
90007-1528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-713-3114
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2008