Provider First Line Business Practice Location Address:
5850 S MAIN 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:
90003-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-846-4312
Provider Business Practice Location Address Fax Number:
323-846-4464
Provider Enumeration Date:
09/16/2006