Provider First Line Business Practice Location Address:
1151 6TH STREET
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:
90017-1828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-639-2562
Provider Business Practice Location Address Fax Number:
213-385-9246
Provider Enumeration Date:
01/10/2007