Provider First Line Business Practice Location Address:
1655 E 27TH ST STE B
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:
90011-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-537-0110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2013