Provider First Line Business Practice Location Address:
2422 W FLORENCE AVE
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:
90043-5105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-541-9100
Provider Business Practice Location Address Fax Number:
310-541-9191
Provider Enumeration Date:
10/01/2008