Provider First Line Business Practice Location Address:
4545 E CESAR E CHAVEZ AVE STE 1E
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:
90022-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-265-2699
Provider Business Practice Location Address Fax Number:
323-265-4273
Provider Enumeration Date:
02/01/2008