Provider First Line Business Practice Location Address:
816 S INDIANA 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:
90023-1820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-262-5432
Provider Business Practice Location Address Fax Number:
323-262-5730
Provider Enumeration Date:
10/05/2006