Provider First Line Business Practice Location Address:
3242 W 8TH 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:
90005-2176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-383-0007
Provider Business Practice Location Address Fax Number:
213-383-0019
Provider Enumeration Date:
11/18/2011