Provider First Line Business Practice Location Address:
3461 W 3RD 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:
90020-1604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-382-5971
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2013