Provider First Line Business Practice Location Address:
637 SOUTH LUCAS AVENUE
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90017-2395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-977-0520
Provider Business Practice Location Address Fax Number:
213-977-0504
Provider Enumeration Date:
07/07/2006