Provider First Line Business Practice Location Address:
3145 S CANFIELD AVE APT 13
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:
90034-4352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-558-8085
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2007