Provider First Line Business Practice Location Address:
1523 N LA BREA
Provider Second Line Business Practice Location Address:
SUITE # 206
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-882-6387
Provider Business Practice Location Address Fax Number:
323-661-5466
Provider Enumeration Date:
01/03/2007