Provider First Line Business Practice Location Address:
749 S UNION 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:
90017-2115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-483-5616
Provider Business Practice Location Address Fax Number:
213-483-5633
Provider Enumeration Date:
07/21/2006