Provider First Line Business Practice Location Address:
1711 W TEMPLE ST
Provider Second Line Business Practice Location Address:
STE 7136
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90026-7336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-663-2150
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2006