Provider First Line Business Practice Location Address:
4545 E 3RD ST
Provider Second Line Business Practice Location Address:
#102
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90022-1656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-266-7888
Provider Business Practice Location Address Fax Number:
323-266-7997
Provider Enumeration Date:
11/20/2009