Provider First Line Business Practice Location Address:
3760 W 54TH 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:
90043-2335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-321-3559
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2012