Provider First Line Business Practice Location Address:
1620 E. 83RD STREET
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:
90001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-999-4667
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2013