Provider First Line Business Practice Location Address:
1422 W 11TH 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:
90015-1228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-784-4568
Provider Business Practice Location Address Fax Number:
213-459-1305
Provider Enumeration Date:
06/05/2007