Provider First Line Business Practice Location Address:
639 S NEW HAMPSHIRE AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90005-1362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-387-9400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2006