Provider First Line Business Practice Location Address:
1720 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:
90059-3052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-668-3096
Provider Business Practice Location Address Fax Number:
310-223-0910
Provider Enumeration Date:
09/13/2012