Provider First Line Business Practice Location Address:
1224 VINE ST.
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:
90038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-769-6177
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2007