Provider First Line Business Practice Location Address:
11101 S MAIN 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:
90061-1925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-755-6646
Provider Business Practice Location Address Fax Number:
323-776-1106
Provider Enumeration Date:
08/02/2010