Provider First Line Business Practice Location Address:
1029 1/2 S BERENDO 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:
90006-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-388-1250
Provider Business Practice Location Address Fax Number:
213-388-1350
Provider Enumeration Date:
11/17/2010