Provider First Line Business Practice Location Address:
312 W 5TH ST STE 103
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:
90013-1981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-622-5696
Provider Business Practice Location Address Fax Number:
213-622-5932
Provider Enumeration Date:
12/26/2006