Provider First Line Business Practice Location Address:
1711 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:
90026-5421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-989-6148
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2006