Provider First Line Business Practice Location Address:
414 S WESTERN AVE # A
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:
90020-4103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-384-2288
Provider Business Practice Location Address Fax Number:
213-739-3498
Provider Enumeration Date:
03/01/2007