Provider First Line Business Practice Location Address:
3915 E 2ND 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:
90063-3613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-262-2354
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2012