Provider First Line Business Practice Location Address:
258 S OXFORD AVE STE 102
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:
90004-5172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-500-6162
Provider Business Practice Location Address Fax Number:
323-468-9536
Provider Enumeration Date:
10/09/2007