Provider First Line Business Practice Location Address:
971 E 43RD 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:
90011-3040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-778-5433
Provider Business Practice Location Address Fax Number:
323-232-7190
Provider Enumeration Date:
07/19/2005