Provider First Line Business Practice Location Address:
522 W 127TH ST STE 313
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:
90044-7002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-418-1620
Provider Business Practice Location Address Fax Number:
323-418-1620
Provider Enumeration Date:
11/06/2009