Provider First Line Business Practice Location Address:
648 E 21ST 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:
90011-1146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-749-7110
Provider Business Practice Location Address Fax Number:
213-749-2749
Provider Enumeration Date:
10/10/2007