Provider First Line Business Practice Location Address:
3900 W 3RD 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:
90020-2675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-382-6485
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2007