Provider First Line Business Practice Location Address:
1134 S WESTERN AVE B 2
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:
90006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-219-9718
Provider Business Practice Location Address Fax Number:
323-731-0426
Provider Enumeration Date:
06/08/2011