Provider First Line Business Practice Location Address:
183 N MARTEL AVE STE 210
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:
90036-2756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-927-2595
Provider Business Practice Location Address Fax Number:
323-676-1452
Provider Enumeration Date:
06/03/2008