Provider First Line Business Practice Location Address:
163 S. AVENUE 24 SUITE 203 & 204
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:
90031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-546-3500
Provider Business Practice Location Address Fax Number:
323-638-1253
Provider Enumeration Date:
08/05/2006