Provider First Line Business Practice Location Address:
1841 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:
90047-5021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-750-2850
Provider Business Practice Location Address Fax Number:
323-750-0851
Provider Enumeration Date:
10/24/2013