Provider First Line Business Practice Location Address:
1215 ARMACOST AVE APT 202
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:
90025-1443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-525-1963
Provider Business Practice Location Address Fax Number:
877-852-5845
Provider Enumeration Date:
01/27/2006