Provider First Line Business Practice Location Address:
1621 COLORADO BLVD
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:
90041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-344-0448
Provider Business Practice Location Address Fax Number:
323-256-0727
Provider Enumeration Date:
12/26/2007