Provider First Line Business Practice Location Address:
420 ORD ST
Provider Second Line Business Practice Location Address:
SUITE 102-A
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90012-2834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-617-0136
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2007