Provider First Line Business Practice Location Address:
8635 WEST 3RD ST
Provider Second Line Business Practice Location Address:
STE 355W
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-655-7610
Provider Business Practice Location Address Fax Number:
888-808-0270
Provider Enumeration Date:
07/16/2006