Provider First Line Business Practice Location Address:
4278 W 3RD 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:
90020-3449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-366-0388
Provider Business Practice Location Address Fax Number:
213-368-0389
Provider Enumeration Date:
09/15/2006