Provider First Line Business Practice Location Address:
645 W 9TH ST
Provider Second Line Business Practice Location Address:
638
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90015-1640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-700-3964
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2011