Provider First Line Business Practice Location Address:
3594 E 1ST 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:
90063-4144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-268-3258
Provider Business Practice Location Address Fax Number:
323-268-9162
Provider Enumeration Date:
02/15/2007