Provider First Line Business Practice Location Address:
1112 N VIRGIL AVENUE
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:
90029-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-665-1208
Provider Business Practice Location Address Fax Number:
323-665-1203
Provider Enumeration Date:
03/06/2007