Provider First Line Business Practice Location Address:
600 S LA FAYETTE PARK PL # 117
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:
90057-3215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-382-2630
Provider Business Practice Location Address Fax Number:
213-382-2631
Provider Enumeration Date:
07/14/2006