Provider First Line Business Practice Location Address:
112 W 9TH ST STE 1126
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:
90015-1569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-493-1401
Provider Business Practice Location Address Fax Number:
213-403-5608
Provider Enumeration Date:
01/16/2009