Provider First Line Business Practice Location Address:
628 W 52ND PL
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:
90037-3706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-846-1000
Provider Business Practice Location Address Fax Number:
323-846-1011
Provider Enumeration Date:
12/08/2008