Provider First Line Business Practice Location Address:
993 N BROADWAY
Provider Second Line Business Practice Location Address:
SUITE. A
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90012-1728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-625-7995
Provider Business Practice Location Address Fax Number:
213-625-7997
Provider Enumeration Date:
07/06/2006