Provider First Line Business Practice Location Address:
443 1/2 SO ATLANTIC BLVD
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:
90022-2617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-266-1745
Provider Business Practice Location Address Fax Number:
310-274-4094
Provider Enumeration Date:
10/05/2006