Provider First Line Business Practice Location Address:
3663 W 6TH ST STE 207
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:
90020-3048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-383-2080
Provider Business Practice Location Address Fax Number:
213-383-2082
Provider Enumeration Date:
06/11/2008