Provider First Line Business Practice Location Address:
2256 COLORADO BLVD
Provider Second Line Business Practice Location Address:
STE. 111
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90041-1164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-982-1435
Provider Business Practice Location Address Fax Number:
323-982-1485
Provider Enumeration Date:
09/01/2006