Provider First Line Business Practice Location Address:
3663 W 6TH ST STE 106
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:
90020-3047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-381-7272
Provider Business Practice Location Address Fax Number:
213-529-4117
Provider Enumeration Date:
10/03/2006