Provider First Line Business Practice Location Address:
8425 W 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90048-4126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-525-0249
Provider Business Practice Location Address Fax Number:
323-525-0490
Provider Enumeration Date:
05/16/2006