Provider First Line Business Practice Location Address:
163 S AVENUE 24
Provider Second Line Business Practice Location Address:
SUITES 201-205
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90031-2299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-984-7416
Provider Business Practice Location Address Fax Number:
310-312-5553
Provider Enumeration Date:
11/28/2013