Provider First Line Business Practice Location Address:
3367 W 1ST ST STE 201
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:
90004-6080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-483-4246
Provider Business Practice Location Address Fax Number:
213-483-7257
Provider Enumeration Date:
03/16/2012