Provider First Line Business Practice Location Address:
9307 S CENTRAL AVE
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:
90002-2017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-564-6982
Provider Business Practice Location Address Fax Number:
323-564-5970
Provider Enumeration Date:
05/24/2016