Provider First Line Business Practice Location Address:
610 S BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90014-1824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-622-5696
Provider Business Practice Location Address Fax Number:
213-622-5932
Provider Enumeration Date:
10/11/2005