Provider First Line Business Practice Location Address:
3030 W TEMPLE ST STE 108
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:
90026-4529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-427-3565
Provider Business Practice Location Address Fax Number:
213-252-9599
Provider Enumeration Date:
08/15/2006