Provider First Line Business Practice Location Address:
548 S CHIACAGO 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:
90033-4424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-304-6060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2007