Provider First Line Business Practice Location Address:
1680 COLORADO 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:
90041-1436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-254-6736
Provider Business Practice Location Address Fax Number:
323-254-8772
Provider Enumeration Date:
11/11/2005