Provider First Line Business Practice Location Address:
520 E TEMPLE ST
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:
90012-4024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
999-999-9999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/29/2016