Provider First Line Business Practice Location Address:
680 WILSHIRE PL
Provider Second Line Business Practice Location Address:
STE 311
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90005-3931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-386-2044
Provider Business Practice Location Address Fax Number:
213-386-2347
Provider Enumeration Date:
01/27/2012