Provider First Line Business Practice Location Address:
3130 W 6TH ST STE 1
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:
90020-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-382-5650
Provider Business Practice Location Address Fax Number:
213-382-1443
Provider Enumeration Date:
01/07/2008