Provider First Line Business Practice Location Address:
711 W COLLEGE ST
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90012-1163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-621-2998
Provider Business Practice Location Address Fax Number:
213-621-2158
Provider Enumeration Date:
08/30/2006