Provider First Line Business Practice Location Address:
2100 E 1ST 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:
90033-3918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-268-6819
Provider Business Practice Location Address Fax Number:
323-268-8018
Provider Enumeration Date:
08/10/2006