Provider First Line Business Practice Location Address:
5618 N FIGUEROA 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:
90042-4102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-254-6108
Provider Business Practice Location Address Fax Number:
323-254-6109
Provider Enumeration Date:
11/08/2006