Provider First Line Business Practice Location Address:
124 N WESTERN AVE
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:
90004-4106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-464-3925
Provider Business Practice Location Address Fax Number:
323-464-3220
Provider Enumeration Date:
12/18/2006