Provider First Line Business Practice Location Address:
925 W 34TH ST
Provider Second Line Business Practice Location Address:
RM 144
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90089-0641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-740-5094
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2013