Provider First Line Business Practice Location Address:
2716 N BROADWAY STE 214
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:
90031-2635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-221-5931
Provider Business Practice Location Address Fax Number:
323-221-6952
Provider Enumeration Date:
03/20/2007