Provider First Line Business Practice Location Address:
600 610 S. HARVARD BLVD
Provider Second Line Business Practice Location Address:
STE 104
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-380-3016
Provider Business Practice Location Address Fax Number:
213-380-8536
Provider Enumeration Date:
06/28/2007