Provider First Line Business Practice Location Address:
1919 W 7TH ST UNIT M
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:
90057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-674-7577
Provider Business Practice Location Address Fax Number:
213-674-7799
Provider Enumeration Date:
04/11/2011