Provider First Line Business Practice Location Address:
711 W COLLEGE ST
Provider Second Line Business Practice Location Address:
STE 530
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90012-1163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-617-2923
Provider Business Practice Location Address Fax Number:
213-226-5469
Provider Enumeration Date:
07/28/2006