Provider First Line Business Practice Location Address:
8474 W 3RD ST STE 112
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:
90048-4142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-655-7979
Provider Business Practice Location Address Fax Number:
323-655-7913
Provider Enumeration Date:
07/30/2006