Provider First Line Business Practice Location Address:
279 S ATLANTIC BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90022-1734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-624-5333
Provider Business Practice Location Address Fax Number:
213-624-5999
Provider Enumeration Date:
05/17/2007