Provider First Line Business Practice Location Address:
520 S VIRGIL AVE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90020-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-234-5575
Provider Business Practice Location Address Fax Number:
213-427-9850
Provider Enumeration Date:
06/09/2006