Provider First Line Business Practice Location Address:
THE JOHN MCKAY CTR
Provider Second Line Business Practice Location Address:
940 WEST 35TH ST
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90089-0602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-761-6553
Provider Business Practice Location Address Fax Number:
213-740-0504
Provider Enumeration Date:
12/28/2011