Provider First Line Business Practice Location Address:
1414 S GRAND AVE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90015-3067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-484-3272
Provider Business Practice Location Address Fax Number:
818-647-0402
Provider Enumeration Date:
01/07/2010