Provider First Line Business Practice Location Address:
642 N BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90012-2838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-620-1720
Provider Business Practice Location Address Fax Number:
213-620-8753
Provider Enumeration Date:
09/22/2006