Provider First Line Business Practice Location Address:
3407 W 6TH ST STE 512
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:
90020-2552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-387-9552
Provider Business Practice Location Address Fax Number:
213-387-9553
Provider Enumeration Date:
05/25/2007