Provider First Line Business Practice Location Address:
629 TRACTION AVE APT 112
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:
90013-1680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-723-9316
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2009