Provider First Line Business Practice Location Address:
1720 E 120TH ST
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90059-3052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-668-3403
Provider Business Practice Location Address Fax Number:
310-223-0621
Provider Enumeration Date:
10/27/2006