Provider First Line Business Practice Location Address:
4306 W 8TH ST.
Provider Second Line Business Practice Location Address:
#4
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-621-9491
Provider Business Practice Location Address Fax Number:
323-424-3883
Provider Enumeration Date:
11/12/2007