Provider First Line Business Practice Location Address:
1125 WEST 6TH STREET
Provider Second Line Business Practice Location Address:
SUITE 103
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-241-0979
Provider Business Practice Location Address Fax Number:
213-241-0925
Provider Enumeration Date:
08/20/2009