Provider First Line Business Practice Location Address:
2501 COLORADO BLVD STE H
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:
90041-1055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-340-3962
Provider Business Practice Location Address Fax Number:
323-340-3963
Provider Enumeration Date:
04/24/2007