Provider First Line Business Practice Location Address:
1440 E 41ST 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:
90011-3304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-231-2585
Provider Business Practice Location Address Fax Number:
323-231-8771
Provider Enumeration Date:
08/18/2015