Provider First Line Business Practice Location Address:
1711 W TEMPLE ST
Provider Second Line Business Practice Location Address:
SUITE #5657
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CALIFORNIA
Provider Business Practice Location Address Postal Code:
90026
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
213-484-6995
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2008