Provider First Line Business Practice Location Address:
1640 WEST 70TH STREET
Provider Second Line Business Practice Location Address:
1640 WEST 70TH STREET
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-668-6908
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2006