Provider First Line Business Practice Location Address:
874 W MARTIN LUTHER KING JR 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:
90037-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-232-6161
Provider Business Practice Location Address Fax Number:
323-232-1501
Provider Enumeration Date:
08/30/2011