Provider First Line Business Practice Location Address:
111 EAST AVE 26
Provider Second Line Business Practice Location Address:
RITE AID
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90031-2312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-222-8876
Provider Business Practice Location Address Fax Number:
323-223-0144
Provider Enumeration Date:
06/15/2010