Provider First Line Business Practice Location Address:
730 S WESTERN AVE STE 202
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:
90005-5901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-385-3828
Provider Business Practice Location Address Fax Number:
213-385-2144
Provider Enumeration Date:
12/26/2006