Provider First Line Business Practice Location Address:
981 S WESTERN AVE
Provider Second Line Business Practice Location Address:
SUITE 200A
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90006-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-731-0707
Provider Business Practice Location Address Fax Number:
323-731-0729
Provider Enumeration Date:
10/22/2007