Provider First Line Business Practice Location Address:
1530 S OLIVE 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:
90015-3023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-746-1037
Provider Business Practice Location Address Fax Number:
213-746-9379
Provider Enumeration Date:
02/20/2007