Provider First Line Business Practice Location Address:
5715 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:
90037-4131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-948-0444
Provider Business Practice Location Address Fax Number:
323-948-0443
Provider Enumeration Date:
03/03/2014