Provider First Line Business Practice Location Address:
1224 VINE ST
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:
90038-1612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-266-3432
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2009