Provider First Line Business Practice Location Address:
124 N VIGNES 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:
90012-4030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-626-5679
Provider Business Practice Location Address Fax Number:
213-680-0185
Provider Enumeration Date:
06/24/2013