Provider First Line Business Practice Location Address:
203A HERITAGE HALL
Provider Second Line Business Practice Location Address:
3501 WATT WAY
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90089-0602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-740-5845
Provider Business Practice Location Address Fax Number:
213-740-0504
Provider Enumeration Date:
09/01/2006