Provider First Line Business Practice Location Address:
245 S FETTERLY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90022-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-362-1400
Provider Business Practice Location Address Fax Number:
323-362-1373
Provider Enumeration Date:
01/16/2018