Provider First Line Business Practice Location Address:
619 E 5TH 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:
90013-2109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-688-4816
Provider Business Practice Location Address Fax Number:
213-488-2121
Provider Enumeration Date:
05/20/2009