Provider First Line Business Practice Location Address:
637 LUCAS AVE
Provider Second Line Business Practice Location Address:
#205
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90017-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-977-9704
Provider Business Practice Location Address Fax Number:
213-977-9714
Provider Enumeration Date:
02/25/2011