Provider First Line Business Practice Location Address:
3240 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE # 290
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90010-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-382-0052
Provider Business Practice Location Address Fax Number:
213-382-5122
Provider Enumeration Date:
12/12/2006