Provider First Line Business Practice Location Address:
810 E. 111TH STREET
Provider Second Line Business Practice Location Address:
ROOM # 113 & 114
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-585-8985
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2012