Provider First Line Business Practice Location Address:
3663 W. 6TH ST.
Provider Second Line Business Practice Location Address:
SUITE #105
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-730-8900
Provider Business Practice Location Address Fax Number:
323-730-1758
Provider Enumeration Date:
02/20/2007