Provider First Line Business Practice Location Address:
1127 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
STE 809
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90017-3909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-745-4060
Provider Business Practice Location Address Fax Number:
213-745-4073
Provider Enumeration Date:
03/14/2007