Provider First Line Business Practice Location Address:
6505 8TH AVE
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:
90043-4313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-541-1600
Provider Business Practice Location Address Fax Number:
323-541-1665
Provider Enumeration Date:
10/21/2008