Provider First Line Business Practice Location Address:
6336 W 3RD 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:
90036-3155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-934-0099
Provider Business Practice Location Address Fax Number:
323-934-0099
Provider Enumeration Date:
12/06/2006