Provider First Line Business Practice Location Address:
12021 S. WILMINGTON AVE.
Provider Second Line Business Practice Location Address:
BLDG. 18, SUITE 300
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90059-3019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-842-2577
Provider Business Practice Location Address Fax Number:
213-477-2159
Provider Enumeration Date:
09/04/2015