Provider First Line Business Practice Location Address:
1025 WEST 34TH STREET (KOH) 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:
90089-0028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-740-2738
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2013