Provider First Line Business Practice Location Address:
7410 S. BROADWAY BLVD.
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:
90003-7734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-541-9016
Provider Business Practice Location Address Fax Number:
323-541-9192
Provider Enumeration Date:
03/09/2007