Provider First Line Business Practice Location Address:
2426 W 8TH ST
Provider Second Line Business Practice Location Address:
SUITE # 214
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-3979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-739-7907
Provider Business Practice Location Address Fax Number:
213-739-7908
Provider Enumeration Date:
12/21/2006