Provider First Line Business Practice Location Address:
117 N AVENUE 59
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:
90042-4262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-737-1610
Provider Business Practice Location Address Fax Number:
626-737-7146
Provider Enumeration Date:
10/17/2013