Provider First Line Business Practice Location Address:
13305 S SAN PEDRO 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:
90061-2254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-424-6531
Provider Business Practice Location Address Fax Number:
562-424-5071
Provider Enumeration Date:
11/27/2012