Provider First Line Business Practice Location Address:
672 S. LA FAYETTE PAEK PL, SUITE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-381-3226
Provider Business Practice Location Address Fax Number:
213-380-8923
Provider Enumeration Date:
03/11/2011