Provider First Line Business Practice Location Address:
1744 W 6TH 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:
90017-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-413-2458
Provider Business Practice Location Address Fax Number:
213-413-9621
Provider Enumeration Date:
07/19/2010