Provider First Line Business Practice Location Address:
1453 W TEMPLE
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:
90026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-780-0361
Provider Business Practice Location Address Fax Number:
213-241-0925
Provider Enumeration Date:
07/25/2011