Provider First Line Business Practice Location Address:
1314 WILSHIRE BLVD.
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:
90017-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-384-5132
Provider Business Practice Location Address Fax Number:
213-234-4542
Provider Enumeration Date:
08/15/2006