Provider First Line Business Practice Location Address:
3407 W 6TH ST
Provider Second Line Business Practice Location Address:
STE 700
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-384-7084
Provider Business Practice Location Address Fax Number:
213-384-5673
Provider Enumeration Date:
09/01/2006