Provider First Line Business Practice Location Address:
1711 W TEMPLE ST FL 7
Provider Second Line Business Practice Location Address:
SUITE 7606
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90026-5421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-207-5030
Provider Business Practice Location Address Fax Number:
213-273-8391
Provider Enumeration Date:
11/07/2006