Provider First Line Business Practice Location Address:
1111 W 6TH ST STE 111
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:
90017-1823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-404-1027
Provider Business Practice Location Address Fax Number:
323-340-8298
Provider Enumeration Date:
09/28/2007