Provider First Line Business Practice Location Address:
850 COLORADO BLVD
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90041-1762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-553-1884
Provider Business Practice Location Address Fax Number:
213-236-9662
Provider Enumeration Date:
11/15/2010