Provider First Line Business Practice Location Address:
1339 E 120TH 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:
90059-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-755-2742
Provider Business Practice Location Address Fax Number:
310-876-0533
Provider Enumeration Date:
07/09/2009