Provider First Line Business Practice Location Address:
3028 W 4TH 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:
90020-1163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-305-3002
Provider Business Practice Location Address Fax Number:
661-945-2495
Provider Enumeration Date:
10/12/2006