Provider First Line Business Practice Location Address:
981 S WESTERN AVE RM 307
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:
90006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-500-8432
Provider Business Practice Location Address Fax Number:
213-388-7763
Provider Enumeration Date:
12/20/2006