Provider First Line Business Practice Location Address:
925 W 34TH STREET SPECIAL PATIENTS CLINIC
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:
90089-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-740-5094
Provider Business Practice Location Address Fax Number:
213-740-8100
Provider Enumeration Date:
06/10/2009