Provider First Line Business Practice Location Address:
420 E 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 809
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90013-1644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-687-0424
Provider Business Practice Location Address Fax Number:
213-687-7172
Provider Enumeration Date:
07/18/2006