Provider First Line Business Practice Location Address:
898 TEMPLE TER UNIT 123
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:
90042-5032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-709-3610
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2009