Provider First Line Business Practice Location Address:
2222 LAVERNA 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:
90041-2660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-550-4242
Provider Business Practice Location Address Fax Number:
323-550-4224
Provider Enumeration Date:
11/04/2016