Provider First Line Business Practice Location Address:
1241 S SOTO ST
Provider Second Line Business Practice Location Address:
117
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90023-2652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-264-2410
Provider Business Practice Location Address Fax Number:
323-264-2241
Provider Enumeration Date:
04/18/2007