Provider First Line Business Practice Location Address:
4521 E. CESAR CHAVEZ 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:
90022-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-269-4509
Provider Business Practice Location Address Fax Number:
323-269-4509
Provider Enumeration Date:
06/29/2006