Provider First Line Business Practice Location Address:
2121 W TEMPLE 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:
90026-4915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-260-7640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2007