Provider First Line Business Practice Location Address:
3120 W 6TH 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:
90020-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-385-0871
Provider Business Practice Location Address Fax Number:
213-386-0923
Provider Enumeration Date:
10/11/2005