Provider First Line Business Practice Location Address:
3715 S MCCLINTOCK 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:
90089-0191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-550-6725
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2011