Provider First Line Business Practice Location Address:
1500 S MCDONNELL AVE
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:
90040-5623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-981-4308
Provider Business Practice Location Address Fax Number:
323-269-2541
Provider Enumeration Date:
11/14/2006