Provider First Line Business Practice Location Address:
1935 GATES 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:
90031-3151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-222-8835
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2009