Provider First Line Business Practice Location Address:
1680 VINE ST
Provider Second Line Business Practice Location Address:
1013
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90028-8804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-650-3959
Provider Business Practice Location Address Fax Number:
818-782-0616
Provider Enumeration Date:
04/14/2007