Provider First Line Business Practice Location Address:
1617 N. EL CENTRO AVENUE
Provider Second Line Business Practice Location Address:
SUITE #16
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-344-0440
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2009