Provider First Line Business Practice Location Address:
3776 S GRAMERCY PL
Provider Second Line Business Practice Location Address:
ONE HALF
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90018-4377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-470-6474
Provider Business Practice Location Address Fax Number:
626-578-0948
Provider Enumeration Date:
02/23/2012