Provider First Line Business Practice Location Address:
2533 W 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-1947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-483-1921
Provider Business Practice Location Address Fax Number:
213-483-7891
Provider Enumeration Date:
12/25/2012