Provider First Line Business Practice Location Address:
213 E 139TH 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:
90061-2115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-538-2010
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2011