Provider First Line Business Practice Location Address:
837 W IMPERIAL HWY
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:
90044-4110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-755-9555
Provider Business Practice Location Address Fax Number:
323-755-9545
Provider Enumeration Date:
04/18/2017