Provider First Line Business Practice Location Address:
871 1/2 W 47TH 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:
90037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-334-1787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2010