Provider First Line Business Practice Location Address:
3429 ANDRITA ST
Provider Second Line Business Practice Location Address:
1
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90065-2952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-605-6055
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2013