Provider First Line Business Practice Location Address:
2121 W TEMPLE ST BLDG ABC
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:
90026-4915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-744-9055
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2017