Provider First Line Business Practice Location Address:
2400 W 7TH ST STE 114
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:
90057-5008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-389-9595
Provider Business Practice Location Address Fax Number:
213-389-2556
Provider Enumeration Date:
03/17/2009