Provider First Line Business Practice Location Address:
1503 W MARTIN LUTHER KING JR BLVD
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:
90062-1743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-298-7543
Provider Business Practice Location Address Fax Number:
323-298-7952
Provider Enumeration Date:
12/28/2006