Provider First Line Business Practice Location Address:
1047 W 24TH 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:
90007-1816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-744-1404
Provider Business Practice Location Address Fax Number:
213-747-5280
Provider Enumeration Date:
04/10/2007