Provider First Line Business Practice Location Address:
547 N JUNE ST
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:
90004-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-464-3040
Provider Business Practice Location Address Fax Number:
323-465-7303
Provider Enumeration Date:
12/03/2007