Provider First Line Business Practice Location Address:
1107 N WESTERN AVE
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:
90029-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-461-8331
Provider Business Practice Location Address Fax Number:
323-461-8332
Provider Enumeration Date:
12/13/2006