Provider First Line Business Practice Location Address:
420 E THIRD ST
Provider Second Line Business Practice Location Address:
SUITE 903
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-617-0266
Provider Business Practice Location Address Fax Number:
213-617-7332
Provider Enumeration Date:
09/12/2006