Provider First Line Business Practice Location Address:
2898 ROWENA AVE.
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-667-0297
Provider Business Practice Location Address Fax Number:
323-667-1311
Provider Enumeration Date:
05/01/2007