Provider First Line Business Practice Location Address:
1273 S UNION AVE
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:
90015-2043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-380-3124
Provider Business Practice Location Address Fax Number:
213-380-5595
Provider Enumeration Date:
07/30/2006