Provider First Line Business Practice Location Address:
923 W 53RD 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:
90037-3613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-742-3083
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2010