Provider First Line Business Practice Location Address:
1330 WEST IMPERIAL HIGHWAY
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:
90044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-418-3101
Provider Business Practice Location Address Fax Number:
323-757-4099
Provider Enumeration Date:
12/28/2007