Provider First Line Business Practice Location Address:
1430 SAN JULIAN ST
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:
90015-3142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-202-7584
Provider Business Practice Location Address Fax Number:
213-580-6559
Provider Enumeration Date:
05/16/2006