Provider First Line Business Practice Location Address:
1711 NORTH VAN NESS
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:
90028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-436-3533
Provider Business Practice Location Address Fax Number:
562-436-1007
Provider Enumeration Date:
04/24/2007