Provider First Line Business Practice Location Address:
1721 E. 120TH ST.
Provider Second Line Business Practice Location Address:
TRAILER 6
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-266-3164
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2013