Provider First Line Business Practice Location Address:
4151 WEST 3RD STREET
Provider Second Line Business Practice Location Address:
#B
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-250-8822
Provider Business Practice Location Address Fax Number:
213-250-8844
Provider Enumeration Date:
10/28/2008