Provider First Line Business Practice Location Address:
2615 S GRAND AVE
Provider Second Line Business Practice Location Address:
RM 507H
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90007-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-745-0811
Provider Business Practice Location Address Fax Number:
213-743-4864
Provider Enumeration Date:
02/28/2008