Provider First Line Business Practice Location Address:
1828 E CESAR E CHAVEZ AVE
Provider Second Line Business Practice Location Address:
C-225
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-261-0259
Provider Business Practice Location Address Fax Number:
323-261-0073
Provider Enumeration Date:
11/15/2006