Provider First Line Business Practice Location Address:
1711 W TEMPLE ST
Provider Second Line Business Practice Location Address:
SUITE 3681
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90026-5421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-989-0776
Provider Business Practice Location Address Fax Number:
213-989-0703
Provider Enumeration Date:
03/14/2007