Provider First Line Business Practice Location Address:
1726 E. 117TH 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:
90059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-566-1965
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2012