Provider First Line Business Practice Location Address:
3932 WILSHIRE BLVD
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:
90010-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-386-3336
Provider Business Practice Location Address Fax Number:
213-386-2935
Provider Enumeration Date:
01/25/2006