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 ANGELESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-668-5150
Provider Business Practice Location Address Fax Number:
310-223-0695
Provider Enumeration Date:
03/11/2010