Provider First Line Business Practice Location Address:
531 E 36TH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-222-4855
Provider Business Practice Location Address Fax Number:
323-370-6759
Provider Enumeration Date:
05/06/2009