Provider First Line Business Practice Location Address:
727 N VINE ST
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:
90038-3713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-466-7158
Provider Business Practice Location Address Fax Number:
323-461-2684
Provider Enumeration Date:
04/25/2007