Provider First Line Business Practice Location Address:
1143 S LOS ANGELES 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:
90015-2536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-770-7309
Provider Business Practice Location Address Fax Number:
213-612-4936
Provider Enumeration Date:
02/18/2009