Provider First Line Business Practice Location Address:
490 S SAN VICENTE BLVD STE 3
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:
90048-4132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-655-9055
Provider Business Practice Location Address Fax Number:
323-655-9255
Provider Enumeration Date:
06/30/2005