Provider First Line Business Practice Location Address:
1540 ALCAZAR ST
Provider Second Line Business Practice Location Address:
BLDG CHP 133
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90089-0080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-442-3550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2013