Provider First Line Business Practice Location Address:
3663 WEST 6TH STREET
Provider Second Line Business Practice Location Address:
SUITE 307
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:
213-736-1884
Provider Business Practice Location Address Fax Number:
213-736-1885
Provider Enumeration Date:
10/05/2006