Provider First Line Business Practice Location Address:
628 S MCBRIDE AVE
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:
90022-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-278-4378
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2009