Provider First Line Business Practice Location Address:
2516 W. 54TH STREET
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:
90043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-296-6573
Provider Business Practice Location Address Fax Number:
310-670-2626
Provider Enumeration Date:
02/17/2011