Provider First Line Business Practice Location Address:
2200 W 3RD ST STE 120B
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:
90057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-484-7310
Provider Business Practice Location Address Fax Number:
213-484-7320
Provider Enumeration Date:
08/24/2005