Provider First Line Business Practice Location Address:
942 N BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90012-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-680-9393
Provider Business Practice Location Address Fax Number:
213-680-2921
Provider Enumeration Date:
11/06/2006