Provider First Line Business Practice Location Address:
2297 W 21ST 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:
90018-1327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-737-6240
Provider Business Practice Location Address Fax Number:
323-731-4150
Provider Enumeration Date:
03/14/2006