Provider First Line Business Practice Location Address:
8520 S BROADWAY
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:
90003-3335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-284-3124
Provider Business Practice Location Address Fax Number:
323-905-1995
Provider Enumeration Date:
10/12/2006