Provider First Line Business Practice Location Address:
1305 S CONCORD 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:
90023-3503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-981-9816
Provider Business Practice Location Address Fax Number:
323-889-7808
Provider Enumeration Date:
09/19/2013