Provider First Line Business Practice Location Address:
814 FRANCISCO 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:
90017-2530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-497-5774
Provider Business Practice Location Address Fax Number:
301-491-7071
Provider Enumeration Date:
07/09/2006