Provider First Line Business Practice Location Address:
5801 S SAN PEDRO ST
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:
90011-5323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-238-0445
Provider Business Practice Location Address Fax Number:
323-230-6271
Provider Enumeration Date:
10/18/2012