Provider First Line Business Practice Location Address:
1427 W JEFFERSON BLVD
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:
90007-3419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-730-8063
Provider Business Practice Location Address Fax Number:
323-730-8063
Provider Enumeration Date:
09/01/2007