Provider First Line Business Practice Location Address:
1045 ATLANTIC AVENUE
Provider Second Line Business Practice Location Address:
SUITE 712
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-491-4879
Provider Business Practice Location Address Fax Number:
562-491-7987
Provider Enumeration Date:
02/21/2007