Provider First Line Business Practice Location Address:
3311 W 3RD ST
Provider Second Line Business Practice Location Address:
APT 1-238
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90020-1616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-449-6740
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2013