Provider First Line Business Practice Location Address:
903 S CRENSHAW BLVD
Provider Second Line Business Practice Location Address:
SUITE 102A
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90019-1964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-935-4000
Provider Business Practice Location Address Fax Number:
323-937-8970
Provider Enumeration Date:
06/26/2006