Provider First Line Business Practice Location Address:
420 S SAN PEDRO ST APT 226
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:
90013-2186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-924-8889
Provider Business Practice Location Address Fax Number:
213-927-3654
Provider Enumeration Date:
03/29/2007