Provider First Line Business Practice Location Address:
8631 W. THIRD ST
Provider Second Line Business Practice Location Address:
#240E
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-854-3412
Provider Business Practice Location Address Fax Number:
310-854-5732
Provider Enumeration Date:
02/24/2012