Provider First Line Business Practice Location Address:
1414 S GRAND AVE STE 123
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:
90015-3071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-455-8448
Provider Business Practice Location Address Fax Number:
213-745-8922
Provider Enumeration Date:
01/20/2009