Provider First Line Business Practice Location Address:
211 S AVENUE 20
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:
90031-2508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-436-3533
Provider Business Practice Location Address Fax Number:
562-436-0043
Provider Enumeration Date:
07/17/2012