Provider First Line Business Practice Location Address:
2426 W 8TH ST STE 105
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:
90057-3840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-388-4415
Provider Business Practice Location Address Fax Number:
213-388-4631
Provider Enumeration Date:
03/05/2007