Provider First Line Business Practice Location Address:
3030 W TEMPLE ST STE 207
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:
90026-4560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-318-5975
Provider Business Practice Location Address Fax Number:
213-318-5976
Provider Enumeration Date:
04/14/2025