Provider First Line Business Practice Location Address:
616 SHATTO PL
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:
90005-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-738-8853
Provider Business Practice Location Address Fax Number:
213-738-5368
Provider Enumeration Date:
08/16/2007