Provider First Line Business Practice Location Address:
1701 E CESAR E CHAVEZ AVE
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-2464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-264-4300
Provider Business Practice Location Address Fax Number:
323-264-4664
Provider Enumeration Date:
09/20/2006