Provider First Line Business Practice Location Address:
505 S. VIRGIL AVE.
Provider Second Line Business Practice Location Address:
SUITE 202
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:
213-382-0022
Provider Business Practice Location Address Fax Number:
213-382-0020
Provider Enumeration Date:
04/09/2007