Provider First Line Business Practice Location Address:
2214 S HOOVER 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:
90007-1848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-622-3100
Provider Business Practice Location Address Fax Number:
866-867-2392
Provider Enumeration Date:
01/14/2017