Provider First Line Business Practice Location Address:
8631 WEST 3RD STREET,
Provider Second Line Business Practice Location Address:
SUITE 540E
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-999-5677
Provider Business Practice Location Address Fax Number:
213-260-9356
Provider Enumeration Date:
01/13/2010