Provider First Line Business Practice Location Address:
1477 S CANFIELD AVE APT 205
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:
90035-3272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-397-6552
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2009