Provider First Line Business Practice Location Address:
4220 WEST 3RD ST
Provider Second Line Business Practice Location Address:
SUITE #100
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:
213-381-3855
Provider Business Practice Location Address Fax Number:
213-381-3856
Provider Enumeration Date:
11/21/2006