Provider First Line Business Practice Location Address:
771 E 9TH 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:
90021-1839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-247-9346
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2008