Provider First Line Business Practice Location Address:
1711 W TEMPLE ST
Provider Second Line Business Practice Location Address:
5606
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90026-5421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-413-1133
Provider Business Practice Location Address Fax Number:
213-413-1101
Provider Enumeration Date:
10/23/2006