Provider First Line Business Practice Location Address:
2822 S WESTERN 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:
90018-3032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-734-9600
Provider Business Practice Location Address Fax Number:
323-734-9300
Provider Enumeration Date:
01/11/2008