Provider First Line Business Practice Location Address:
1801 E MARENGO ST
Provider Second Line Business Practice Location Address:
ROOM 1G1
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-1365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-226-3813
Provider Business Practice Location Address Fax Number:
323-226-5049
Provider Enumeration Date:
02/14/2007