Provider First Line Business Practice Location Address:
906 S SOTO 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:
90023-1323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-263-9064
Provider Business Practice Location Address Fax Number:
323-264-5655
Provider Enumeration Date:
12/13/2006