Provider First Line Business Practice Location Address:
1361 EXPOSITION 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:
90018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-216-2252
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2010