Provider First Line Business Practice Location Address:
5318-5320 S. BROADWAY
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:
90037-3808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-249-9097
Provider Business Practice Location Address Fax Number:
323-249-9121
Provider Enumeration Date:
02/20/2015