Provider First Line Business Practice Location Address:
3800 E CESAR E CHAVEZ AVE
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:
90063-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-264-6296
Provider Business Practice Location Address Fax Number:
323-264-6297
Provider Enumeration Date:
06/15/2015