Provider First Line Business Practice Location Address:
5042 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
505
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90036-4305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-505-6534
Provider Business Practice Location Address Fax Number:
213-607-3214
Provider Enumeration Date:
02/15/2012