Provider First Line Business Practice Location Address:
2323 W 8TH ST
Provider Second Line Business Practice Location Address:
#106
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-383-3536
Provider Business Practice Location Address Fax Number:
213-383-3537
Provider Enumeration Date:
09/26/2006