Provider First Line Business Practice Location Address:
1453 W TEMPLE ST
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90026-9002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-804-8257
Provider Business Practice Location Address Fax Number:
213-241-0925
Provider Enumeration Date:
12/01/2014