Provider First Line Business Practice Location Address:
1001 S BROADWAY STE F
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-749-9966
Provider Business Practice Location Address Fax Number:
213-277-5865
Provider Enumeration Date:
07/26/2007