Provider First Line Business Practice Location Address:
2858 W 8TH 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:
90005-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-365-2858
Provider Business Practice Location Address Fax Number:
213-365-3855
Provider Enumeration Date:
09/22/2012