Provider First Line Business Practice Location Address:
343 E 116TH ST
Provider Second Line Business Practice Location Address:
343 E. 116TH STREET
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90061-2913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-779-0048
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2008