Provider First Line Business Practice Location Address:
5919 W 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 1-E
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90036-2833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-930-9662
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2007