Provider First Line Business Practice Location Address:
3484 E 1ST 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:
90063-2946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-553-5203
Provider Business Practice Location Address Fax Number:
310-652-0933
Provider Enumeration Date:
01/19/2017