Provider First Line Business Practice Location Address:
4110 W 3RD 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:
90020-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-386-2580
Provider Business Practice Location Address Fax Number:
213-386-2582
Provider Enumeration Date:
05/23/2007