Provider First Line Business Practice Location Address:
928 S WESTERN AVE STE 231
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:
90006-1083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-214-2875
Provider Business Practice Location Address Fax Number:
213-214-2875
Provider Enumeration Date:
01/25/2011