Provider First Line Business Practice Location Address:
656 N BROADWAY
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:
90012-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-617-7888
Provider Business Practice Location Address Fax Number:
213-617-7241
Provider Enumeration Date:
08/25/2005