Provider First Line Business Practice Location Address:
334 E 2ND ST # B
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:
90012-4203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-628-7419
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2006