Provider First Line Business Practice Location Address:
1891 EFFIE 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:
90026-1711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-644-2000
Provider Business Practice Location Address Fax Number:
323-315-1169
Provider Enumeration Date:
04/07/2016