Provider First Line Business Practice Location Address:
4220 W THIRD STREET #208
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:
90020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-386-3554
Provider Business Practice Location Address Fax Number:
213-386-3575
Provider Enumeration Date:
09/27/2006