Provider First Line Business Practice Location Address:
1625 E 4TH 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:
90033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-268-8391
Provider Business Practice Location Address Fax Number:
323-268-8014
Provider Enumeration Date:
01/27/2009