Provider First Line Business Practice Location Address:
2411 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:
90026-4817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-380-3210
Provider Business Practice Location Address Fax Number:
213-382-0595
Provider Enumeration Date:
05/25/2006