Provider First Line Business Practice Location Address:
4848 CIVIC CENTER WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90022-1678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-949-1388
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2009