Provider First Line Business Practice Location Address:
1542 E FLORENCE AVE
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:
90001-2536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-584-0222
Provider Business Practice Location Address Fax Number:
323-584-0634
Provider Enumeration Date:
07/15/2005