Provider First Line Business Practice Location Address:
3217 MINNESOTA 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:
90031-2827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-225-4694
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2010