Provider First Line Business Practice Location Address:
112 W 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 1126
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90015-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-354-2602
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2012