Provider First Line Business Practice Location Address:
2208 W 7TH 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:
90057-4002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-637-2530
Provider Business Practice Location Address Fax Number:
213-384-3373
Provider Enumeration Date:
06/17/2013