Provider First Line Business Practice Location Address:
2208 W 7TH STREET
Provider Second Line Business Practice Location Address:
ATTN: YVETTE HARGROVE BROWN
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-303-0779
Provider Business Practice Location Address Fax Number:
928-832-5713
Provider Enumeration Date:
07/15/2009