Provider First Line Business Practice Location Address:
1513 S. GRAND AVE.
Provider Second Line Business Practice Location Address:
SUTE 208
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-765-8088
Provider Business Practice Location Address Fax Number:
213-765-8181
Provider Enumeration Date:
04/18/2007