Provider First Line Business Practice Location Address:
1740 S LOS ANGELES ST STE 104
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:
90015-3631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-742-7777
Provider Business Practice Location Address Fax Number:
213-742-0808
Provider Enumeration Date:
10/17/2006