Provider First Line Business Practice Location Address:
4754 E CESAR E CHAVEZ 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:
90022-1234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-909-0041
Provider Business Practice Location Address Fax Number:
323-909-0042
Provider Enumeration Date:
07/18/2006