Provider First Line Business Practice Location Address:
2829 S GRAND AVE
Provider Second Line Business Practice Location Address:
ADMINISTRATIVE OFFICE
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90007-3304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-744-3676
Provider Business Practice Location Address Fax Number:
213-202-5991
Provider Enumeration Date:
02/27/2007