Provider First Line Business Practice Location Address:
420 E 3RD ST STE 904
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:
90013-1647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-947-3171
Provider Business Practice Location Address Fax Number:
213-947-3173
Provider Enumeration Date:
11/13/2006