Provider First Line Business Practice Location Address:
2723 WEST 54TH ST
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:
90043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-912-9139
Provider Business Practice Location Address Fax Number:
310-290-5377
Provider Enumeration Date:
02/26/2010