Provider First Line Business Practice Location Address:
625 W COLLEGE ST
Provider Second Line Business Practice Location Address:
#104
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-617-0096
Provider Business Practice Location Address Fax Number:
213-621-1642
Provider Enumeration Date:
01/02/2008