Provider First Line Business Practice Location Address:
351 E TEMPLE ST
Provider Second Line Business Practice Location Address:
MAIL CODE LAACC HOME BASED PRIMARY CARE A127A
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90012-3328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-253-5018
Provider Business Practice Location Address Fax Number:
213-253-5018
Provider Enumeration Date:
01/25/2012