Provider First Line Business Practice Location Address:
3217 ETTRICK 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:
90027-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-927-5451
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2011