Provider First Line Business Practice Location Address:
141 S. FELTERLY AVE
Provider Second Line Business Practice Location Address:
EAST LA SEA
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-264-7996
Provider Business Practice Location Address Fax Number:
323-264-1121
Provider Enumeration Date:
04/24/2007