Provider First Line Business Practice Location Address:
712 1/2 N VAN NESS AVE
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:
90038-3108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-988-4051
Provider Business Practice Location Address Fax Number:
213-426-0813
Provider Enumeration Date:
05/07/2007