Provider First Line Business Practice Location Address:
706 W 1ST 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:
90012-2442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-621-2652
Provider Business Practice Location Address Fax Number:
213-621-2654
Provider Enumeration Date:
05/20/2010