Provider First Line Business Practice Location Address:
3411 W 8TH 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:
90005-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-385-7979
Provider Business Practice Location Address Fax Number:
213-388-7975
Provider Enumeration Date:
10/31/2011