Provider First Line Business Practice Location Address:
403 WEST ADAMS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-742-1402
Provider Business Practice Location Address Fax Number:
213-742-1103
Provider Enumeration Date:
10/08/2012