Provider First Line Business Practice Location Address:
3710 W MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
SUITE 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:
90008-1793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-299-4357
Provider Business Practice Location Address Fax Number:
310-943-1599
Provider Enumeration Date:
08/20/2015