Provider First Line Business Practice Location Address:
11613 W WASHINGTON 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:
90066-5915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-637-9700
Provider Business Practice Location Address Fax Number:
213-637-9705
Provider Enumeration Date:
03/22/2006