Provider First Line Business Practice Location Address:
1907 E WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90021-3206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-747-7667
Provider Business Practice Location Address Fax Number:
213-747-9618
Provider Enumeration Date:
07/14/2011