Provider First Line Business Practice Location Address:
3242 W 8TH ST STE 103
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:
90005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-880-0605
Provider Business Practice Location Address Fax Number:
213-381-0011
Provider Enumeration Date:
10/20/2011