Provider First Line Business Practice Location Address:
748 N BROADWAY
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:
90012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-617-8686
Provider Business Practice Location Address Fax Number:
626-799-8921
Provider Enumeration Date:
03/12/2007