Provider First Line Business Practice Location Address:
1711 W TEMPLE ST STE 6657
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:
90026-7338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-484-5250
Provider Business Practice Location Address Fax Number:
213-263-2120
Provider Enumeration Date:
07/08/2011