Provider First Line Business Practice Location Address:
4016 S CENTRAL AVE
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:
90011-2708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-233-7274
Provider Business Practice Location Address Fax Number:
323-233-3675
Provider Enumeration Date:
02/13/2014