Provider First Line Business Practice Location Address:
1425 S MARIPOSA AVE
Provider Second Line Business Practice Location Address:
#104
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90006-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-734-3411
Provider Business Practice Location Address Fax Number:
323-734-3411
Provider Enumeration Date:
11/16/2007